Helicobacter pylori infection is an important risk factor for peptic ulcer disease and eradication of H. pylori infection decrease the complication and recurrence of peptic ulcer disease.To determine the efficacy and safety of ciprofloxacin in bismuth based quadruple regimens in eradication of H. pylori infection. Eighty-five patients with duodenal ulcer and H. pylori infection that were confirmed by endoscopy and rapid urease test completed this study in Ghaem hospital of Mashad University of Medical Sciences - Iran. The patients were randomly divided in two groups A and B. Patients in group A received metronidazole 2x500 mg. + omeprazole 2x20 mg. + bismuth s.c. 2x240 mg. + amoxicilin 2x1 gr. for 2 weeks and group B receivedciprofloxacin2x500 mg. + omeprazole2x20 mg. + bismuth S.C.2x240 mg. + amoxicilin2xl gr. for2 weeks. Both groups received ranitidine 150 mg twice daily for another 30 days. At least one week after completion of therapy urea breath test (UBT)is performed for assessment of eradication. Statistical analysis was performed by SPSS software. Chi-square tests and T-test groups and X2 were used to compare the eradication rates. The patients underwent a second line regimens therapy (cross treatment) only if they had a positive UBT.All patients tolerated the medications. The mean age in-group A and B were 45.42 and 42.93 years respectively. Eradication rate of H. pylori infection were 76.7% and 73.8% in-groups A and B respectively (p = 0.75). Only 11 out of 21 patients who failed H. pylori eradication switched to second line therapy (cross treatment) and H. pylori eradicate were achieved in 3 of 3 patients in metronidazole group and 3 of 8 patients in ciprofloxacin group respectively. Although side effects were seen less frequently in ciprofloxacin group, the difference was not. statistically significant. We conclude that use of ciprofloxacin in bismuth s. C., based quadruple therapy for eradication of helicobacter pylori is not superior to regimens which contains metronidazole.

Statement of Problem: Gingival overgrowth is a side effect commonly induced by Cyclosporine treatment. The effects of Azithromycin, a macrolidic antibiotic, have been focused on gingival enlargement treatment induced by cyclosporine in numerous articles.Purpose: The goal of the present study was to survey the effects of systemic Azithromycin in the treatment of gingival overgrowth induced by cyclosporine among renal transplant patients.Materials and Methods: In this clinical trial study, 18 renal transplant patients (6 females and 12 males) with gingival overgrowth were studied. Samples were randomly divided into two groups: case group were treated by systemic Azithromycin and controls were treated by systemic placebo. Periodontal parameters including bleeding on probing (BOP), clinical crown length (CL), periodontal pocket depth (PPD), gingival overgrowth (GOI) and stent-IDP (vertical distant between a stent or plate with teeth occlusal planes at least from three of the most anterior contact points to mesial papillae) before treatment, two and six weeks after treatment were measured. To analyze the data, Wilcoxon and Mann-Whitney tests were used.Results: Most of the measured indices, among case and control groups, were significantly improved, after two weeks (P<0.05). No statistically significant differences were found between two groups except for BOP index (P<0.05). In other words, more BOP improvement was observed in the case group after six weeks comparing to the control group.Conclusion: Considering the findings of this study, one can assume that the reported effects of Azithromycine on gingival overgrowth, induced by cyclosporine are somehow exaggerated and the effects attributed this medicine is probably inflammation reduction.

Background: In developing countries primary antibiotic-resistance and poor compliance are the main causes of helicobacter pylori (HP) eradication failure of standard regimens. AIM: To investigate eradication rate, patient's compliance and tolerability of a 1-wk Azithromycin based quaruple therapy versus the 2-wk conventional therapy.Materials and Methods: A total of 129 HP-positive patients were randomized to either omeprazole 20mg, bismuth subcitrate 240 mg, azithromycin 250 mg, metronidazole 500 mg, all twice daily for 1- wk (BOAzM) or omeprazole 20mg, bismuth subcitrate 240 mg, amoxicillin 1g, metronidazole 500 mg all twice daily for 2-wk (B-OAM). HP infection was defined at entry by histology and rapid urease test and cure of infection was determined by negative urea breath test.Results: HP eradication rates of B-OAzM and B-OAM were74.1% and 70.4% respectively at intention to treat and per-protocol analysis 78.1%versus 75.7% respectively. incidence of poor compliance was lower, although not significant, in patients randomized to B-OAzM than for B-OAM (3.5% versus 4.3 %) but intolerability was similar in two groups ( 35% versus 33.3% ).  Conclusions: 1-wk azithromycin based quadruple regimen achieves an HP eradication rate comparable to that of standard 2-wk quadruple Therapy and is associated with same patient's compliance and complications.

Introduction: The prevalence of active asthma in Iran is between 2.8%-3.8%. A lot of treatments exist for acute and chronic asthma. The goal of chronic asthma treatment is achieve to a condition without any symptoms with a good function of lung by using the lowest dose of drugs. The aim of this survey is comparing the rate of clinical recovery and lungs function finding in persist asthma patient before and after treatment. Material and Methods: We conducted a prospective self-control clinical trial and enrolled 30 persistent asthma patient who came to lung clinics of Baqiyatallah(a.s) hospital. In the six month of 2007. By using history, physical exams, spirometry and completing questionary. Then patient treat by azithromycin protocol and prednisolone. Results: The mean age was 44.36±25.8 years old. The mean BMI of patient was 25.8±4.2kg/m2. Twelve patients (40%) were male and 18 patients (60%) were female. The mean of FVC percent before and after treatment with full dose were 68.03±18.03 and 70.69±14.44 respectively (p<0.226) and after treating by Azithromycin & prednisolone was 81.61±20.1 (p<0.004). The mean of FEV1 percent before and after treatment with full dose were 56.69±20.45 and 60.37 ±17.2 respectively (p<0.085) and after treating by Azithromycin & prednisolone was 79.58±16.9 (p<0.0001). The mean of FEV1/FVC before and after treatment with full dose were 66.78±12.15 and 66.97±12.6 respectively (p<0.446) and after treating by Azithromycin&prednisolone was 78.11±11.08 (p<0.0001). Discussion: We use Azithromycin instead of increasing the dose of prednisolone because patient didn’t show a good response to full dose and the response was good. In spite of lack of control group for Azithromycin treatment, this survey shows that instead of increasing the dose of prednisolone we can use Azithromycin.

Background and aim: Complications and resistance to pentavalent antimonial agents in cutaneous leishmaniasis, exhibit the need for effective alternative drugs. The aim of this study was to compare the efficacy of oral azithromycin with systemic meglumine antimoniate (Glucantime) in the treatment of cutaneous leishmaniasis. Materials and Methods: Forty-seven patients with cutaneous leishmaniasis visited at the dermatology department of Qaem hospital were randomly divided to two groups. Twenty patients (with 29 lesions) were treated with oral azithromycin 500 mg/day for 5 successive days each month for 4 months and 27 patients (with 58 lesions) were treated with systemic Glucantime 60 mg/kg/day for 20 days. Azithromycin group patients were visited monthly and control group patients were visited in last day of treatment and 45 days later. Results: At the end of our study 10.3% of lesions in azithromycin group showed complete response, 27.6% lesions partial response and 62.1% no response. In Glucantime group 34.5% of lesions showed complete response, 13.8% partial response and 51.7% no response (P=0.036). Conclusion: In treatment of cutaneous leishmaniasis systemic Glucantime is superior to oral azithromycin. Differences between our result and previous studies may be due to difference between strains of Leishmanias and in vitro. studies may be necessary to resolve this paradox. On the other hand, change in dosage and course of treatment with azithromycin may affect the efficacy of this agent.

Introduction: Bronchiolitis Obliterans (BO) is known as a side effect of sulfur mustard (SM) exposure. Long term prescription of low dose macrolides has been found to be effective in BO. There is no report on the side effects of these drugs on sulfur mustard-induced BO. We compared the side effects of Erythromycin (EM), a member of macrolide family, with low-doses (400 mg daily) for 6 months versus placebo in treatment of BO induced by S M.Materials and Methods: This study was a double blind clinicaltrial carried out in Chemical Injuries Research Center of Baqyatallah (a.s.) University of Medical Sciences. 120 SM- induced BO patients were categorized randomly in group 1 (n=60, EM 400 mg daily) and group 2 (n=60, Placebo). Patients received EM or placebo during a 6-month period. Side effects such as headache, maculopapular rash, pharyngitis, nausea, diarrhea, abdominal pain, dizziness, vomiting, fever and icter were assessed and compared in both groups before and after treatment. Results: The most common side effects in group 1 were pharyngitis (36.36%) and headache (36.36%), and in group 2 pharyngitis (37.50%) and maculopapular rash (37.50%). The prevalence of headache, abdominal pain, icter, dizziness, vomiting and diarrhea in group 1 was more than group 2 (p<0.05).Discussion: According to the previous studies which demonstrated severity of side effects of EM resulted in decreasing use of it and its therapeutic outcomes, it is recommended to use other macrolides like clarythromycin and azythromycin in Bronchiolitis Obliterans due to sulfur mustard.

Objective: Haemophilus influenzae type b (Hib) is a most frequent cause of invasive diseases such as meningitis, septic arthritis and pneumonia in children under 5 years old. Asymptomatic oropharyngeal colonization is an origin of distribution of microorganism to others and probable bacteremia in the same child. The aim of this study was to determine antibiotic susceptibility of Hib in Tehran day care centers. Material & Methods: Hib was isolated from oropharynx of 1000 children visiting 25 day care centers selected randomly in different parts of Tehran city during second half of year 2005. For antibiotic susceptibility determination we used disk diffusion test. Findings: Ampicillin resistance% and Beta lactamase was 32.3 production was seen in 23.6%. Cephalosporins resistance except for cefixime was between 10% to 20% and in cefixime was 58.8%. Rifampin resistance was 17.6%. Resistance to studied macrolids including azythromycin and clarythromycin was 19.6% and 35.3%. Conclusion: On the base of high antibiotic resistance to Hib in our study and other similar studies in Iran, we recommend to use optimal effective and proper antibiotics to decrease the high rate of antibiotics resistance to Hib colonization and its invasive diseases.

Erythromycin was the first macolide discovered in 1952. In 1990s new macrolides including clarithromycin, azithromycin, and dirithromycin were introduced to the market. We provide a review of their structure, pharmacokinetics. mechanisms of action, and indications in dermatology.

Background and objective: Acute bacterial sinusitis (ABS) is an acute infection of the paranasal sinuses and nose most commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. In this study was compared the efficacy and safety of azithromycin (AZM) regimen, to the efficacy and safety of an amoxicillin-clavulanate (AMC) regimen.Material and methods: A total of 80 subjects (male 60%,female 40% ,mean age 32.7 years) 8 years of age or older with clinical diagnosis of ABS of sinuses upon entry into the study. Diagnosis was confirmed by the presence of either purulent nasal discharge or facial pain and/or pressure and/or tightness & X rays positive of sinuses. These patients were treated by azithromycin and coamoxiclave.Result: Clinical success rates were at the end of therapy (AZM-5, 37.5%; AMC, 72.5%). Subjects treated with AMC reported a higher incidence of treatment-related adverse events (17.5%) than AZM-5 (5%), P<0.001. Gastrointestinal discomfort was the most frequent treatment-related adverse effect.Conclusion: Result of this study demonstrated that AZM provides a better safety profile and better compliance than AMC for the treatment of ABS . Furture investigations of ABS treatment may require with longer duration or higher dose of AZM.

Background & Aim: Recurrent or chronic adenotonsillar infections mainly affect children. The prevalence of potential respiratory pathogens on the adenoid and tonsillar surfaces of children with moderate symptoms of recurrent tonsillopharyngitis and/or adeno tonsillar hypertrophy differs only slightly from that in children without symptoms of adenotonsillar disease. Chlamydia pneumoniae is a common respiratory pathogen which is often found in children. Little is known about the true colonization rate and the localization of the bacteria in the respiratory tract. The findings suggest that Chlamydia pneumoniae is a common pathogen in the adenoids of children undergoing adenoidectomy. The aim was to determine Chlamydia pneumoniae infection in adenoid tissue of adenoidectomized children by PCR and specific antibody in serum.Patients and Methods: In a descriptive cross sectional study during 2005-2006 in ENT department of Rasool Akram hospital, detection of Chlamydia DNA by PCR was performed on 44 adenoid tissue of adenoidectomized children. 168 ELISA tests (IgG&IgM for each sample) were performed. Samples were collected from 53 patients (63.1%) and 31 normal (36.9%) children. The data gathered were analyzed by SPSS 10.5 software.Results: Age of children was between 3-14 years, range 11yr; mean 7.95(SD=1.98years). Also there were 54.8% males and 45.2% females. Season of adenoidectomy was: 24% spring; 18% summer; 36% autumn and 22% in winter. Chlamydia-DNA by PCR was positive in 7(15.9%) of adenoid tissues. Positivity of PCR did not differ with age or sex. Acute chlamydial infection was seen in 3.7%; previous immunity was seen in 12.3% of all children. By serology method in 51 patients, acute chlamydia infection was detected in 1(2%) and previous immunity in 6(11.8%). Acute and previous infections did not differ significantly between case and control group.Conclusion: The results suggest that Chlamydia pneumoniae (C. Pneumoniae) is a common finding in the adenoids of children undergoing adenoidectomy. The adenoid tissue, may act as a reservoir for bacteria causing sinusitis, lung and chronic ear infection. Whether or not C. pneumoniae plays a pathogenic role in this group of patients could not be determined from the data obtained in this investigation. In cases of resistant adenoiditis to usual drugs, we recommend the use of specific antibiotics for Chlamydia (appropriate for age) including erythromycin, tetracycline or other new macrolids (e.g azithromycin, clarythromycin) before surgery.