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Impact of furazolidone-based quadruple therapy for eradication of Helicobacter pylori after previous treatment failures.

BACKGROUND: One week of quadruple therapy including metronidazole is recommended for Helicobacter pylori treatment failures after first line therapy regardless of resistance status. This study investigated whether a quadruple regimen containing furazolidone could be effective as a third-line (salvage) therapy. METHODS: All patients with previous H. pylori treatment failure after a clarithromycin-metronidazole +/- amoxicillin combination plus acid suppression were given lansoprazole 30 mg twice a day (bid), tripotassiumdicitratobismuthate 240 mg bid, tetracycline 1 g bid, metronidazole 400 mg (PPI-B-T-M) three times a day (tid) for 1 week. In the case of treatment failure with this second-line therapy, the same regimen was applied for 1 week except for using furazolidone 200 mg bid (PPI-B-T-F) instead of metronidazole (sequential study design). RESULTS: Eighteen consecutive patients were treated with PPI-B-T-M. Eleven of those 18 remained H. pylori positive (38.9% cured). Pretherapeutic metronidazole resistance was associated with a lower probability of eradication success (10% vs. 75%, p=.04). Ten of these 11 patients agreed to be retreated by PPI-B-T-F. Final cure of H. pylori with PPI-B-T-F was achieved in 9/10 patients (90%) nonresponsive to PPI-B-T-M. CONCLUSIONS: In the presence of metronidazole resistance, PPI-B-T-M as a recommended second-line therapy by the Maastricht consensus conference achieved unacceptable low cure rates in our metronidazole pretreated population. In this population, metronidazole based second-line quadruple therapy may be best suited in case of a metronidazole-free first line-regimen (e.g. PPI-clarithromycin-amoxicillin) or a low prevalence of metronidazole resistance. Furazolidone in the PPI-B-T-F combination does not have a cross-resistance potential to metronidazole and is a promising salvage option after a failed PPI-B-T-M regimen.

Anti-Bacterial Agents↗

Semen characteristics in furazolidone-treated goats.

Furazolidone was given to male Nubian goats for 5 days at a therapeutic dose of 10 mg/kg or at a dose of 40 mg/kg, and the effect on semen morphology and biochemistry was studied. At the lower dose, furazolidone significantly reduced seminal ejaculate volume, the number of motile spermatozoa per ejaculate and the number of live spermatozoa per ejaculate, while secondary abnormalities increased. At a dose of 40 mg/kg, the same effects were produced and there were significant reductions in wave motion, percentage of motile spermatozoa and percentage of live spermatozoa. Fructose concentration was significantly reduced with both the doses, while citric acid was not affected by either one. Alkaline phosphatase activity was lower with 10 mg/kg of furazolidone and increased when the larger dose was administered.

Animals↗

Identification of a furazolidone metabolite responsible for the inhibition of amino oxidases.

1 Furazolidone, a drug widely used in human and veterinary medicine, exhibits inhibition of monoamine oxidase activity, as observed in the tissues of a number of different animal species, including man. The aim of the current study was to determine which of the two possible metabolites, 3-amino-2-oxazolidone (AOZ) or beta-hydroxyethylhydrazine (HEH), a well-known carcinogenic compound, is involved in the toxicological effects reported. 2 A new spectrometric method was set up to differentiate intracellular HEH from AOZ inside cells. This method works well at low pH where both AOZ and HEH are free in solution and available to react with the chemical chromophore (DAB). 3 The results confirm that furazolidone has to be metabolized in the intact cell in order to exhibit mitochondrial monoamine oxidase inhibition, whereas AOZ itself is able to exert a reversible monoamine oxidase inhibition. AOZ also inhibits bovine serum amino oxidase. On the contrary, HEH gives irreversible inhibition of both enzymes. However, the reversible nature of the AOZ inhibition with respect to HEH suggests that the two metabolites act by different mechanisms which do not require the biotransformation of AOZ to HEH. 4 Cell lysates, previously incubated with AOZ, were directly analysed and the formation of HEH from AOZ was not detected, supporting the conclusion that the amino oxidase inhibition observed on treatment with furazolidone was attributable to AOZ and not to HEH.

Animals↗

The effect of furazolidone on the adrenal glands of the chicken.

In the chicken, the weights of the adrenal and thyroid glands (as percentages of body weight) were selectively increased following administration of furazolidone (0.04 per cent w/w in the feed, 10 days). The increase in the weight of the adrenal glands most probably represents hypertrophy of the cortex, as the amount of catecholamines in the glands was unaffected by furazolidone. Furazolidone (0.04 per cent w/w, 10 days) produced a small reduction in the concentration of cholesterol in the adrenals. The concentration of ascorbic acid in the gland was unaffected by the drug.

Adrenal Glands↗

Furazolidone residues in chicken and swine tissues after feeding trials.

Broiler chickens and swine fed furazolidone in their diet were sacrificed, and samples of liver, kidney, skin/fat and muscle were harvested and analyzed for furazolidone residue. Chickens fed 200 g of furazolidone/ton of feed were withdrawn from treatment 21, 14, 7, 5, 3, or 0 days before slaughter. Birds withdrawn from medication more than 5 days prior to slaughter had no residues in any of the tissues sampled. One of the 12 birds in each of the 5 day and 3 day withdrawal groups had detectable residues in the skin/fat. Seven of the 12 birds in the 0 day withdrawal group had residues of less than 2 ppb in skin/fat samples. Chickens fed 400 g furazolidone/ton of feed were withdrawn from treatment 0 days before slaughter. Residues of 0.7 to 3.5 ppb were found in the skin of these birds; residues were not found in other tissues. Swine were fed 300 g furazolidone/ton of feed for 2 weeks or 150 g/ton for 5 weeks. They were withdrawn from treatment 10, 7, 5, 3, or 0 days before slaughter. Tissue samples taken from these swine did not contain detectable furazolidone residues.

Adipose Tissue↗

Detection of furazolidone in human biological fluids by high performance liquid chromatography.

Furazolidone has normally been administered as a non-absorbable antimicrobial agent for use in gastrointestinal infections. However, in India and Mexico it has been used successfully for the treatment of typhoid fever. We measured concentrations of furazolidone by high performance liquid chromatography (HPLC) in several biological fluids, after a single oral dose (5 mg/kg). Six healthy adult volunteers and seven children with typhoid fever and ten children with purulent meningitis were studied. In adults the peak serum concentration was less than or equal to 0.84 mg/l and less than or equal to 4.78% of the ingested dose was excreted in the urine. In the children concentrations were similar to those found in volunteers. The cerebrospinal fluid/serum ratio ranged from 1.02 to 5.95 in the meningitis patients. HPLC is a rapid and sensitive method for the quantitation of furazolidone in biological fluids. The minimum detectable concentration was 0.05 mg/l, with a precision of 6% from peak area and an average recovery of 98%.

Adolescent↗

The use of prophylactic furazolidone to control a nosocomial epidemic of multiply resistant Salmonella typhimurium in pediatric wards.

The nosocomial spread of enteric pathogens is often difficult to control in overcrowded pediatric wards. During 1983 and 1984, despite cohorting of patients and enforced hand washing, more than 200 cases of nosocomial multiply resistant Salmonella typhimurium phage type R-9 were observed on two adjacent pediatric wards. Most cases occurred during the summer months. After 19 new cases were detected early in the summer of 1985, oral administration of furazolidone throughout their entire hospital stay (2.5 mg/kg twice daily) was recommended for all subsequently hospitalized infants. Among the 114 (65%) infants who were appropriately treated, only one additional case (1%) was detected. In contrast 11 (19%) cases occurred among the 59 infants who were inappropriately treated: 5 of 35 (14%) of those who were not treated and 6 of 24 (25%) in whom treatment with furazolidone was delayed greater than 24 hours (P less than 0.001 between the appropriately and inappropriately treated groups). In pediatric wards where infection control measures cannot be optimally applied, prophylactic furazolidone administration may be helpful in preventing the spread of enteric pathogens.

Cohort Studies↗

Rifabutin- and furazolidone-based Helicobacter pylori eradication therapies after failure of standard first- and second-line eradication attempts in dyspepsia patients.

BACKGROUND: Optimal management approach is not well defined for subjects who fail initial first- and second-line Helicobacter pylori eradication attempts and are dealt on a case-by-case basis by the specialists. AIM: To evaluate the efficacy and safety of standard and 'rescue' eradication therapies at primary and secondary care levels. METHODS: H. pylori infected dyspepsia patients referred to our C13 urea breath testing laboratory between January 1999 to February 2002 were included. Eradication failure at secondary care level was treated using strategies including antibiotic sensitivity testing and the use of rifabutin- and furazolidone-based therapies. RESULTS: 3280 patients received standard first-line eradication therapy, which was successful in 2530 (77%) patients. Second-line therapy (bismuth-based 'quadruple') or triple therapy (altering constituent antibiotics) was successful in 56% of 270 treated patients. Subsequent eradication attempts using rifabutin-based (n = 34) and furazolidone-based (n = 10) regimens were successful in 38% and 60% patients respectively. H. pylori eradication rates were significantly different for guidelines compliant (94.8%) and non-compliant (82%) groups (P = 0.0001). H. pylori eradication rates for non-ulcer dyspepsia (40%) and peptic ulcer disease (36%) were not significantly different. CONCLUSIONS: Available H. pylori eradication therapies remain very effective and compliance to guidelines achieves high success rates. Furazolidone-based 'rescue' regimen achieved high eradication rates after failure of the standard first-line, second-line and rifabutin-based therapies.

Adolescent↗

Effect of concurrent feeding of furazolidone and sodium chloride upon some clinical, pathological and cardiac morphometric parameters in broiler chicks.

Broiler chicks in different groups were fed furazolidone (0, 400 and 800 mg/kg feed) and sodium chloride (500 and 1510 mg/kg feed) separately and concurrently from 1 to 30 days of age. Furazolidone (Fz) induced ascites, leg weakness, convulsions, depression and mortality was exacerbated by concurrent feeding of 1510 mg NaCl. Hemorrhages in the liver, swollen kidneys, pallor of the kidneys and cystic testes were present in all birds fed furazolidone either alone or in combination with NaCl. However, at microscopic level, necrotic changes were observed in the liver and kidneys of birds fed NaCl only. Fz-induced cardiac ventricular dilatation and thinning of walls were more severe when 400 mg Fz was fed concurrently with 1510 mg NaCl but feeding of 800 mg Fz with the same level of NaCl resulted in partial amelioration of cardiac changes. It is suggested that high dietary NaCl may exacerbate and alter the clinical and morphological picture of Fz toxicosis.

Animals↗

Efficacy of combined furazolidone and neomycin in the control of contamination in Leptospira cultures.

The in vitro effectiveness of furazolidone combined with neomycin for the control of contaminants in Leptospira cultures was investigated. Enhanced additive or synergistic bactericidal activity was apparent with the combination when it was compared with each agent used separately or when compared with 5-fluorouracil. Combined furazolidone and neomycin, at 5-mug/ml concentrations each in Fletcher medium or in implanted sensitivity disks of 50 mug and 10 mug, respectively, was effective in inhibiting contaminants and did not interfere with the growth of leptospira belonging to 66 leptospiral collection serotypes. A simple technique for decontaminating swine kidneys from an abattoir for cultural isolation of leptospiras is described. The method involves exposing renal tissue diluted in saline containing furazolidone and neomycin in combination (each in a concentration of 25 mug/ml) for 1 h prior to inoculating culture media. The method is suitable for routine use in the isolation of leptospiras from contaminated clinical or pathological specimens.

Drug Combinations↗

Enterocytozoon bieneusi in AIDS: symptomatic relief and parasite changes after furazolidone.

AIMS: To investigate changes in morphology of the developmental stages of Enterocytozoon bieneusi and symptomatic relief observed in AIDS patients after treatment with furazolidone. METHODS: Six AIDS patients with symptomatic E bieneusi infection of the small intestine were treated with a course of furazolidone. All patients had a weekly monitoring of parasite shedding in stool by light microscopy during and after treatment. At the end of the treatment, duodenal biopsy specimens obtained from three patients were studied by transmission electron microscopy by two pathologists who were unaware of the patients' treatment. RESULTS: All patients showed both clinical and parasitological response with transient clearance or decrease of spore shedding in stool. After treatment, alterations in faecal spores were observed in all patients by light microscopy, and ultrastructural changes in E bieneusi at all stages of the life cycle were demonstrated in biopsy specimens of the three patients who underwent post-treatment endoscopy. CONCLUSIONS: The clinical benefit seen after treatment with furazolidone in six AIDS patients with E bieneusi intestinal infection may be due to damage to the developmental stages causing a partial inhibition to reproduction of the parasite.

AIDS-Related Opportunistic Infections↗

Persistent damage to Enterocytozoon bieneusi, with persistent symptomatic relief, after combined furazolidone and albendazole in AIDS patients.

AIM: To investigate morphological changes in Enterocytozoon bieneusi and the duration of symptomatic relief after combination treatment with furazolidone and albendazole in AIDS patients. METHODS: Four severely immunocompromised AIDS patients with symptomatic E bieneusi infection of the gut received an 18 day course of combined furazolidone and albendazole (500 + 800 mg daily). All patients were monitored for parasite shedding in stool by light microscopy at the end of treatment and monthly during follow up. At the end of treatment, duodenal biopsy specimens obtained from three patients were studied by transmission electron microscopy by two pathologists blind to the patients' treatment or clinical outcome. Duodenal biopsy specimens obtained from one of the patients two months after completion of treatment were also studied electronmicroscopically. RESULTS: All patients had long lasting symptomatic relief, with a major decrease--or transient absence--of spore shedding in stools from completion of treatment. After treatment, changes in faecal spores were persistently found by light microscopy in all cases, and there was evidence of both a substantial decrease in the parasite load and ultrastructural damage in the parasite in all biopsy specimens. The treatment was well tolerated, and no patient had clinical or parasitological relapse during follow up (up to 15 months). CONCLUSIONS: The long lasting symptomatic relief observed in all four treated patients correlated with the persistent decrease in parasite load both in tissue and in stool, and with the morphological changes observed in the life cycle of the protozoan. These data suggest that combined treatment with furazolidone and albendazole is active against E bieneusi and may result in lasting remission even in severely immunocompromised patients.

AIDS-Related Opportunistic Infections↗

[A therapeutic trial in Giardia muris infection in the mouse with metronidazole, tinidazole, secnidazole and furazolidone].

A comparative study about the effectiveness of metronidazole, tinidazole, secnidazole and furazolidone was performed on Giardia muris from mice naturally infected. Groups of 12 animals each was constituted: the control treated with saline; one treated with metronidazole; one treated with furazolidone; one treated with tinidazole; one treated with secnidazole; histological normal control; histological infected. Samples of three stools were examined before and after treatment with quantification of cysts. Animals were cured when the trophozoites was not seen in the small bowel. The curative activity of drugs was 58.3% for metronidazole, 50% for furazolidone, 40% for secnidazole and 16% for tinidazole. It was also showed that there was a different pattern of the intestinal mucosa from the control and infected groups, treated or not, suggesting that the alterations encountered in the mucosa of infected animals were due to the parasitism either the action of the drugs.

Animals↗

A furazolidone-based quadruple therapy for Helicobacter pylori retreatment in patients with peptic ulcer disease.

PURPOSE: Many of the currently used eradication regimens against Helicobacter pylori fail to cure the infection either due to antimicrobial resistance or to poor patient compliance. The infection leads to increased risk of developing potentially severe complications, such as gastric cancer. This study was aimed at assessing the efficacy and safety of a quadruple therapy with furazolidone for H. pylori retreatment. METHODS: Patients who had failed one or more eradication regimens against H. pylori infection underwent upper gastrointestinal endoscopy. Biopsy specimens were taken from the gastric antrum and corpus for histology and for a urease test and. Patients received omeprazole 20 mg, bismuth citrate 240 mg, tetracycline 500 mg, and furazolidone 200 mg, all twice daily for 7 days. Therapeutic success was evaluated by endoscopy and biopsies 8 weeks after the end of treatment. RESULTS: Sixty two patients were enrolled, and 58 completed the study. Under this protocol, H. pylori eradication was achieved in 39/58 patients (67%). Mild adverse events were reported. CONCLUSION: The short quadruple therapy course with furazolidone is well tolerated, inexpensive, and effective in retreatment for H. pylori infection. It is a good option for developing countries.

Adolescent↗

Effect of furazolidone on gut catecholamine in cysteamine-induced duodenal ulcer in the rat.

The effect of furazolidone, a monoamine oxidase (MAO) inhibitor, on cysteamine-induced duodenal ulcer and gut catecholamines was studied in rats, since previous reports have suggested protective effects of MAO inhibitors against other forms of experimental mucosal injury. Furazolidone (100 mg kg-1, orally) pretreatment significantly reduced the frequency and severity of cysteamine-induced duodenal ulcer. By means of a spectrofluorometric technique, gastric and duodenal norepinephrine concentrations and duodenal dopamine concentrations were measured and found to be increased in animals treated with the MAO inhibitor. It is concluded that the protective effect of furazolidone against cysteamine-induced duodenal ulcer may in part be related to modulation of gut norepinephrine and dopamine concentrations.

Animals↗

Furazolidone and metronidazole for treatment of giardiasis in children.

One hundred children were entered into a randomized study to compare the efficacy and safety of furazolidone and metronidazole when given in liquid suspension for treatment of giardiasis. The study was conducted between May 1985 and February 1986. Dosages were calculated on the basis of body weight, and treatment lasted 10 days. Clinical diagnosis of giardiasis was confirmed by the presence of Giardia cysts in stools. Children were excluded from the study if stool culture was positive for pathogenic bacteria. Eighteen of the 100 children were withdrawn from the study because of noncompliance with the protocol. Of the 82 remaining patients, 37 received furazolidone and 45 metronidazole. No statistically significant differences in efficacy between treatments were found. With the exception of one case of urticaria, which occurred in a patient who received metronidazole, both drugs were well tolerated. In this study, furazolidone and metronidazole were equally safe and effective in treating children with giardiasis.

Adolescent↗

Adverse reactions to furazolidone and other drugs. A comparative review.

Furazolidone is a synthetic nitrofuran with a broad spectrum of antimicrobial action and has been widely used in the treatment of gastrointestinal infections. This article reviews the adverse reactions to furazolidone reported in the world literature. Of 10,443 adults and children who were treated with the drug, approximately 8.3% (864) experienced such reactions. Because some of these patients had more than 1 adverse reaction, 1178 reactions were reported in these studies. Nausea with vomiting, the commonest adverse reaction, was reported by 51% of the 864 patients who experienced adverse reactions. The authors compare the adverse reactions to furazolidone with those reported for other antimicrobial and antiprotozoal drugs that are frequently used to treat gastrointestinal infections.

Adult↗

Recovery of inoculated Salmonella from poultry feed containing furazolidone.

It was determined that the presence of furazolidone, a common feed additive, prevented detection of Salmonella in feed samples. Artificially inoculated Salmonella were not recovered from feed samples containing furazolidone when buffered peptone broth (BP) was used as an enrichment medium, but Salmonella were recovered from all feed samples containing furazolidone when thiol broth was used as a substitute for BP.

Animal Feed↗