Introduction: Peptic ulcer disease (PUD) includes both gastric and duodenal ulcers. There are three major factors which affect its aetiology: Consumption of NSAIDs, Helicobacter pylori infection and hyperacidity state. The objective of the present study is to compare two Anti Helicobacter Pylori eradicative regimens (OCA and OCM) to determine for the preference of replacing Metronidazol with Amoxicillin in Mashhad.Materials and Methods: Randomized sampling was used to select 120 endoscopic proven PUD patients for this study. The patients had referred to the hospitals of Mashhad University of Medical Sciences during the years of 1385-88 (HS). They were equally divided into two groups (60 patients in each group). All the individuals were required to complete a questionnaire and received the Urea Breath Test. Then, the first regimens prescribed for the first group consisted of Omeprazole (20mg/Bid), Clarithromycin (500mg/Q12H), and Amoxicillin (1gr/Q12H). For the second regimen, the patients in the second group were given the same prescription except for Amoxicillin (1gr/Q12H) which was replaced with Metronidazole (500mg/Q12H). Results: H pylori infection was mostly frequent in the third and fourth decades of life. Most of the patients were male with lower level of education. The comparison between the two treatment protocols did not show any meaningful differences (P=0.927).Conclusion: Although the efficacy of these two regimens is near equal, due to better results of Amoxicillin, mainly tolerance and lower complications, OCA regimen is preferred.

Clarithromycin (CLM) is a member of macrolide family with broad spectrum antibiotic activity. It is practically insoluble in water and its poor solubility is pH dependent. In this study, series of nanosuspensions containing CLM and stabilizer such as HPMC, NaCMC, polysorbate 80, poloxamer 188 and polyvinyl alcohol in various ratios were prepared using sonoprecipitation method. Briefly, CLM was dissolved in acid solution and the pH of solution was raised under sonication and the effects of different stabilizers on particle size of nanoparticles were evaluated. Characterization of nanoparticles in terms of size, polydispersity index, zeta potential, differential scanning calorimetery and dissolution studies was performed. Antimicrobial activity of CLM nanosuspension was compared with coarse powder by using an agar well diffusion method. The results showed that HPMC was more efficient in size reduction of particles and presence of HPMC E5 with ratio of 3: 5 to CLM in formulation led to develop the stable nanosuspension with particle size of 340 nm. The obtained nanosuspension successfully showed enhanced dissolution rate and antimicrobial activity.

Background and Objective: Clarithromycin-based quadruple treatment is a common treatment regimen for Helicobacter pylori (H. pylori) eradication in Iran. However, its success rate has been unsatisfactory in recent years due to increasing antibiotic resistance. This study aimed to compare the two treatment regimens, i.e., furazolidone and clarithromycin, for H. pylori eradication. Methods: This descriptive-analytical retrospective study was conducted on the medical records of 100 symptomatic patients (54 females and 46 males; mean age=45.86±11.97 years) confirmed with H. pylori infection via urea breath test (UBT) or rapid urease test (RUT), who presented to Shahid Sayyad Shirazi Educational-Therapeutic Center in Gorgan, Iran, for endoscopy during 2019. Patients had been treated for two weeks with one of two routine oral quadruple drug regimens based on furazolidone and clarithromycin. The first quadruple drug regimen included bismuth subnitrate 240 mg twice daily, clarithromycin 500 mg twice daily, omeprazole 20 mg once daily, and amoxicillin 1000 mg twice daily. The second quadruple drug regimen involved bismuth subnitrate 240 mg twice daily, furazolidone 200 mg twice daily, omeprazole 20 mg once daily, and amoxicillin 1000 mg twice daily. H. pylori eradication rates were determined using a stool antigen test in patients who completed the entire course of treatment (four weeks after the end of the treatment regimen). Results: The eradication rates for the furazolidone-based and clarithromycin-based quadruple regimens were determined to be 98% and 94%, respectively, showing no statistically significant difference. The odds ratio for H. pylori eradication was not statistically significantly associated with age, gender, or treatment regimen type. Conclusion: Both two-week furazolidone-based and clarithromycin-based quadruple regimens were effective in eradicating H. pylori, with neither regimen demonstrating superiority over the other.

Clarithromycin (CLA), a broad-spectrum macrolide, is a poorly soluble drug with dissolution rate limited absorption. The aim of this investigation was to prepare CLA nanoparticles from a ternary ground mixture in the presence of sodium lauryl sulfate (SLS) and polyvinyl pyrrolidone (PVP) as co-grinding water-soluble compounds, in order to improve the drug dissolution rate. Different weight ratios of CLA: SLS: PVP were ground in a dry process by planetary ball mill using different grinding ball size. Following the dissolution rate study, physical properties of the best dissolved co-ground formulation was studied. The accelerated stability studies were also conducted on the co-ground formulation.The results revealed that the dissolution rate of ternary ground mixtures was much higher than that of the intact drug (p<0.001). Decreasing the grinding ball size and weight with the same rotation speed resulted in particles with decreased dissolution. On the other hand, increasing the PVP concentration in the formulations reduced the drug dissolution. Dissolution efficiencies (DE10 and DE30) for the best dissolved formulation, which consisted of the equal ratio of each co-ground component, were 8.7 and 5 folds higher than the untreated CLA, respectively. This formulation formed nanocrystals with enhanced solubility after dispersing in water. X-ray diffraction, differential scanning calorimetry and infrared spectrophotometry confirmed no chemical interaction and phase transition during the process. Accelerated stability studies confirmed that the co-ground mixture almost remained unchanged in terms of dissolution rate, drug assay and particle size after exposing in stability conditions for three months.

Introduction This study investigates the susceptibility and resistance of H. pylori isolates recovered from gastroduodenal patients naive to clarithromycin. Methods To that end, H. pylori strains were isolated from antral biopsies of pretreatment patients, and antral biopsy specimens were subsequently cultured. Presumptive H. pylori colonies were also confirmed on enriched Brucella agar by biochemical tests, including catalase, oxidase, rapid urease, and the standard polymerase chain reaction (PCR) method. The antimicrobial susceptibility testing was performed by standard disk diffusion methods according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Then, the Epsilometer test (E-test) was used to determine the minimal inhibition concentration (MIC).  Results Of 180 samples, 80 (44%) were positive for urease and were included for further analysis. 65 were also positive in culture base method. The sensitivity test indicated a 23% resistance rate to clarithromycin among the six clarithromycin-resistant strains: four have a common form of the A2143G mutation, and two have A2142G mutation. Conclusion The PCR indicated that the level of resistance to clarithromycin was very similar to the resistance level in Iran.

Objectives: The purpose of the study was determining the intestinal permeability of digoxin using the SPIP technique and a range of concentrations in rats and assessing the quantitative contribution of P-gp-mediated efflux in limiting the oral bioavailability of digoxin using erythromycin and clarithromycin as inhibitors of P-gp efflux transporter. Moreover the enhancing effects of the investigated macrolides on digoxin absorption were compared. Methods: The study was performed on jejunal segment of rat. The cannulated segment was perfused by drug solution and samples were obtained from outlet tubing and the remaining drug was assayed. A reverse-phase HPLC method was used for analysis of all samples. Results: Although there were no differences among the obtained permeability coefficients in different concentrations of digoxin, erythromycin and clarithromycin significantly increased the intestinal transport of digoxin (p<0.05).Moreover there was no significant difference between clarithromycin and erythromycin effects on digoxin absorption (P>0.05). Conclusion: At least part of interactions between digoxin and macrolide antibiotics occurs in absorption level. Digoxin can rightly be classified as a low solubility-high permeability Class II BCS drug and its absorption from oral formulations could be affected by erythromycin and clarithromycin. Therefore in dose adjustment for patients using both digoxin and erythromycin or clarithromycin, this important interaction must be considered.

Introduction. Various medication regimens have been used to eradicate Helicobacter pylori in dialysis patients; however, optimal response to treatment is still a challenge. This study aimed to compare response to H pylori eradication in dialysis and nonuremic patients. Materials and Methods. In a randomized controlled trial, dialysis patients with dyspepsia and confirmed positive endoscopic biopsy for H pylori were compared to nonuremic patients. Participants were randomly assigned to receive clarithromycin or levofloxacin. H pylori eradication was assessed using stool antigen test 4 weeks later. Results. Forty-four dialysis and 44 nonuremic patients participated in the study. Four dialysis patients and 2 nonuremic patients did not respond to levofloxacin (P =. 35). Six dialysis patients and 4 nonuremic patients did not respond to clarithromycin (P =. 47). Conclusions. Response rate to H pylori eradication by clarithromycin and levofloxacin was slightly lower in dialysis patients compare to nonuremic patients. In dialysis patients, response rate to levofloxacin was slightly higher than clarithromycin, but the results were not significantly different.