The influence of drug dosage on Helicobacter pylori eradication: a cost-effectiveness analysis.
OBJECTIVE
This review provides an updated overview on Helicobacter pylori (HP) trials, focusing on drug dosage and cost:benefit ratio.


METHODS
Literature review, with analysis of 362 treatments with 13,562 patients.


RESULTS
Statistical evaluation demonstrated the following mean HP eradication rates (ER): 11.7% for monotherapy, 50.7% for dual therapy without acid suppression, 59.8% for dual therapy including acid suppression, 78.1% for triple therapy without acid suppression, 77.5% for triple therapy including acid suppression, and 89.1% for multiple combination therapy (differences between all groups, p < 0.001). In dual therapy, omeprazole/amoxicillin or clarithromycin (mean ER 65.9 vs. 67.6%, NS) showed better results than other combinations. Favorable results in triple therapy were achieved by combined bismuth/imidazoles/tetracycline or by omeprazole/imidazoles/amoxicillin or clarithromycin (mean ER 83.4 vs. 83.5% vs. 93%, NS). The best mean eradication rate, 93.5%, was attained with omeprazole/bismuth/imidazoles/tetracycline. Subgroup analysis revealed a significant correlation between the dose/duration of therapy and the ER for most combinations. The best cost:benefit ratio was demonstrated for omeprazole/imidazoles/clarithromycin (triple therapy including acid suppression).


CONCLUSIONS
The optimal cost:benefit ratio will be achieved by treatment for 1 wk with omeprazole (20 mg/day), imidazoles (such as metronidazole 2 x 400 mg/day), and clarithromycin (2 x 250 mg/day). If dual therapy is taken into account in terms of simplicity and few side effects, the treatment success in the combination of omeprazole ( > or = 2 x 20 mg/day) and amoxicillin ( > or = 2 g/day) or clarithromycin ( > or = 1 g/day), each given for 2 wk, is highly dependent on optimal drug dosage.
Treiber
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Department of Gastroenterology, Robert-Bosch Hospital, Stuttgart, Federal Republic of Germany.
D000658:Amoxicillin / Q000008:administration & dosage; D000863:Antacids / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D001729:Bismuth / Q000008:administration & dosage; D017291:Clarithromycin / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000188:drug therapy; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage; D009853:Omeprazole / Q000008:administration & dosage; D010406:Penicillins / Q000008:administration & dosage; D012044:Regression Analysis; D013276:Stomach Ulcer / Q000188:drug therapy; D013752:Tetracycline / Q000008:administration & dosage; D013997:Time Factors
D000863:Antacids; D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D007093:Imidazoles; D010406:Penicillins; D000658:Amoxicillin; D013752:Tetracycline; D017291:Clarithromycin; D009853:Omeprazole; D001729:Bismuth