A Randomized Controlled Trial Comparing Sequential with Triple Therapy for<i>Helicobacter pylori</i>in an Aboriginal Community in the Canadian North

Morse, Amy L.; Goodman, Karen J.; Munday, Rachel; Chang, Hsiu-Ju; Morse, John Lovett; Keelan, M.; Geary, Janis; Zanten, Sander Veldhuyzen van; Group, CAN Help Working

doi:10.1155/2013/143047

Cited by 25 publications

(28 citation statements)

References 27 publications

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“…High treatment failure rates have been demonstrated elsewhere in the Arctic; Johansen et al reported that 68% of subjects treated with a metronidazole‐based regimen failed the first treatment . Morse et al performed a study that demonstrated high treatment failure rates for clarithromycin‐based standard triple therapy (41%) and clarithromycin‐based sequential therapy (27%) in the northern Northwest Territories of Canada …”

Section: Discussionsupporting

confidence: 92%

“…38 Morse et al performed a study that demonstrated high treatment failure rates for clarithromycin-based standard triple therapy (41%) and clarithromycin-based sequential therapy (27%) in the northern Northwest Territories of Canada. 39 In this study, we documented no change in symptoms post-treatment among patients successfully treated vs those unsuccessfully treated except for stomach pain which appeared to improve posttreatment. These findings are consistent with other studies around the world that demonstrate this lack of symptom resolution posttreatment 40 ; however, there are many other studies with conflicting results, showing a resolution of symptoms.…”

Section: Discussionmentioning

confidence: 55%

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The relationship between previous antimicrobial use, antimicrobial resistance and treatment outcome among Alaskans treated forHelicobacter pyloriinfection

et al. 2019

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Summary Background Helicobacter pylori isolates from Alaska have demonstrated a high prevalence of antimicrobial resistance. Objectives To determine treatment failure in three groups, and analyse the relationship between treatment failure and antimicrobial resistance. Methods Antimicrobial susceptibility was determined using agar dilution and Etest. Treatment success was determined using the urea breath test 2 months after antimicrobial therapy. Results Among 303 treated adult patients, 103 (34%) failed initial treatment despite a 91% compliance with medication. About 222 (73%) patients were treated with a clarithromycin‐based regimen, 55 (18%) with a metronidazole‐based regimen, 15 (5%) with a regimen that contained clarithromycin and metronidazole and 11 (4%) with other antimicrobials. Among 260 culture‐positive patients, 156 (60%) were infected with metronidazole‐resistant isolates, 74 (28%) clarithromycin‐resistant, 52 (20%) clarithromycin/metronidazole‐resistant, 40 (15%) levofloxacin‐resistant, 11 (4%) clarithromycin/metronidazole/levofloxacin‐resistant and nine (3%) amoxicillin‐resistant. Overall, 34% of patients were treated with at least one antibiotic to which their infecting organism was resistant. Among patients treated with clarithromycin‐based regimens, treatment failed in 72% of patients carrying clarithromycin‐resistant H pylori vs 20% with clarithromycin‐sensitive strains (RR = 3.7, P < 0.001). Among patients treated with metronidazole‐based regimens, treatment failed in 19% of patients carrying metronidazole‐resistant H pylori vs 24% with metronidazole‐sensitive strains (P = 0.72). Conclusions A high proportion of H pylori isolates demonstrate resistance to clarithromycin, metronidazole or levofloxacin. Over one third of H pylori‐infected patients were treated with an antibiotic to which their infecting organism demonstrated resistance. Clarithromycin resistance is associated with a greater risk for failure with clarithromycin‐based multidrug regimens compared to clarithromycin‐sensitive; resistance to metronidazole did not affect treatment failure.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 55%

The relationship between previous antimicrobial use, antimicrobial resistance and treatment outcome among Alaskans treated forHelicobacter pyloriinfection

et al. 2019

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“…For instance, the Canadian guidelines recommend against sequential therapy, although only one study was performed in that country [58]. Specifically, a total of 104 patients from Arctic aboriginal community were enrolled, with 51 cases in the sequential therapy and 49 in the triple therapy arm, showing disappointing results for both therapies.…”

Section: Bismuth-free Therapiesmentioning

confidence: 99%

First-line therapies for Helicobacter pylori eradication: a critical reappraisal of updated guidelines

Francesco¹,

Bellesia²,

Manta

et al. 2017

aog

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Helicobacter pylori (H. pylori) treatment remains a challenge for the clinician, as no available therapy is able to cure the infection in all treated patients. In the last two decades, several antibiotic combinations have been proposed, including triple therapies, bismuth-free therapies (sequential, concomitant, hybrid regimens), and bismuth-based quadruple therapy. Some national and international guidelines on H. pylori management have recently been updated, recommending or discouraging the use of each of these therapeutic approaches, based mainly on the presumed pattern of primary antibiotic resistance in different geographic areas. We examined the recommendations on first-line therapies in the most recently updated guidelines worldwide, taking into account other data affecting the efficacy of a therapy regimen beyond the primary resistance pattern. Although several guidelines highlighted that the results achieved by an eradication therapy are population-specific and not directly transferable, it emerged that some therapy regimens are recommended or discouraged with no mention of the vital need for national data.

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“…Thus, there is a need to identify effective H pylori eradication regimens in this at-risk population. In the current issue of the Journal, Morse et al (2) (pages 701-706) report results from a randomized controlled trial comparing sequential versus standard clarithromycin-containing triple therapy in H pylori-infected adults from the community of Aklavik (Northwest Territories) (2). The study was part of a participatory research project focusing on community-identified research goals investigating the burden of H pylori disease in Arctic Aboriginal communities.…”

Section: Anadian Aboriginal Populations Have a High Prevalence Ofmentioning

confidence: 99%

“…In the study by Morse et al (2), H pylori-infected patients >15 years of age were randomly assigned to either a 10-day treatment of standard triple therapy consisting of a proton pump inhibitor (rabeprazole), amoxillicin and clarithromycin, or sequential therapy. Antibiotic resistance rates to clarithromycin and metronidazole were available for almost one-half of the subjects, allowing tailored treatment.…”

Section: Anadian Aboriginal Populations Have a High Prevalence Ofmentioning

confidence: 99%

What is the Best Regimen forHelicobacter pyloriEradication in Canadian Arctic Aboriginals?

Jones

2013

Canadian Journal of Gastroenterology

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A Randomized Controlled Trial Comparing Sequential with Triple Therapy forHelicobacter pyloriin an Aboriginal Community in the Canadian North

Abstract: While additional evidence is needed to confirm that ST is more effective for Arctic Aboriginal communities than the Canadian standard H pylori treatment, these results show standard PPI-CA treatment to be inadequate for communities such as Aklavik.

Cited by 25 publications

References 27 publications

The relationship between previous antimicrobial use, antimicrobial resistance and treatment outcome among Alaskans treated forHelicobacter pyloriinfection

The relationship between previous antimicrobial use, antimicrobial resistance and treatment outcome among Alaskans treated forHelicobacter pyloriinfection

First-line therapies for Helicobacter pylori eradication: a critical reappraisal of updated guidelines

What is the Best Regimen forHelicobacter pyloriEradication in Canadian Arctic Aboriginals?

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