title: A randomized controlled trial comparing sequential with triple therapy for Helicobacter pylori in an Aboriginal community in the Canadian North.
abstract: BACKGROUND
  Helicobacter pylori infection occurs more frequently in Arctic Aboriginal settings than elsewhere in North America and Europe. Research aimed at reducing health risks from H pylori infection has been conducted in the Aboriginal community of Aklavik, Northwest Territories.
  
  
  OBJECTIVE
  To compare the effectiveness of the Canadian standard therapy with an alternative therapy for eliminating H pylori infection in Aklavik.
  
  
  METHODS
  Treatment-naive H pylori-positive individuals were randomly assigned to a 10-day regimen (oral twice-daily doses) with rabeprazole (20 mg): standard triple therapy (proton pump inhibitor, added clarithromycin [500 mg] and amoxicillin [1 g] [PPI-CA]); sequential therapy (ST) added amoxicillin (1 g) on days 1 to 5, and metronidazole (500 mg) and clarithromycin (500 mg) on days 6 to 10. Participants with clarithromycin-resistant H pylori were randomly assigned to ST or quadruple therapy. Treatment effectiveness was estimated as per cent (95% CI) with a negative urea breath test at least 10 weeks after treatment.
  
  
  RESULTS
  Of 104 (53 PPI-CA, 51 ST) randomized participants, 89 (49 PPI-CA, 40 ST) had post-treatment results. Per-protocol treatment effectiveness was 59% (95% CI 45% to 73%) for PPI-CA and 73% (95% CI 58% to 87%) for ST. Based on intention to treat, effectiveness was 55% (95% CI 41% to 69%) for PPI-CA and 57% (95% CI 43% to 71%) for ST. Of 77 participants (43 PPI-CA, 34 ST) with 100% adherence, effectiveness was 63% (95% CI 43% to 82%) for PPI-CA and 81% (95% CI 63% to 99%) for ST.
  
  
  CONCLUSIONS
  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.
authors: Amy L
authors: AL
authors: Morse
authors: Karen J
authors: KJ
authors: Goodman
authors: Rachel
authors: R
authors: Munday
authors: Hsiu-Ju
authors: HJ
authors: Chang
authors: John Wi
authors: JW
authors: Morse
authors: Monika
authors: M
authors: Keelan
authors: Janis
authors: J
authors: Geary
authors: Veldhuyzen van Zanten
authors: Vv
authors: Sander
mesh_terms: D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001944:Breath Tests; D017291:Clarithromycin / Q000008:administration & dosage; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D004930:Inuit; D008297:Male; D055118:Medication Adherence; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D015873:Northwest Territories; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D064750:Rabeprazole / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D064750:Rabeprazole; D000658:Amoxicillin; D017291:Clarithromycin