Considerable use of furazolidone in Iran.

Sir,

Recently, we read a paper by Hasan et al.,[1] suggesting that application of furazolidone in combination with amoxicillin and omeprazole and bismuth subcitrate for two weeks can be a good choice for Helicobacter pylori eradication for dyspeptic patients from Yazd, Iran. However, based on our last publication[2], there are some contradictory findings related to their publication in Saudi Journal of Gastroenterology. Prescribing furazolidone, a new antibiotic for eradication of Helicobacter pylori from the stomach of infected individuals,[3] is still a matter of controversy. Two major topics concerning the widespread use of furazolidone in Iran remain unclear. We have isolated a high rate of resistant strains of H. pylori, as reported in our publication in 2009,[2] which is close to 25% resistance rate for furazolidone. This is high for a new drug in clinical practice. It was expected that furazolidone would not have a high rate of resistance because it has been newly introduced in our country and H. pylori have not been extensively exposed to this antibiotic.

We believe that the Iranian medical community cannot rely on this drug for achieving an effective regimen against H. pylori strains. New data indicating a rising antimicrobial resistance among H. pylori isolates has been seen. This phenomenon has forced us to find new interventions for optimum treatment. Knowing the status of antibiotics resistance to H. pylori can help physicians to determine best treatment of choice against this rogue bacteria.[3] Furthermore, comprehensive follow-up procedures for primary treated patients,[3] especially with drugs such as furazolidone -as a newly proposed treatment- will be helpful for effective eradication of H. pylori.

Second, Hasan et al,[1] used negative rapid urea test (RUT) as confirmation of eradicated infection, a method which has not been recommended by European as well as American guidelines.[45] Results of our new study [data not published] revealed that rising resistance for furazolidone in our H. pylori isolates showed that we are in need of emergency efforts for solving this problem in our country. Until further trials are performed including follow-up with a high sample size for each region and identification of the exact pattern of resistance, we strongly recommend avoiding the use of furazolidone in treatment regimens of H. pylori.