title: Proton pump inhibitor, clarithromycin and either amoxycillin or nitroimidazole: a meta-analysis of eradication of Helicobacter pylori.
abstract: OBJECTIVE
  To perform a meta-analysis of studies comparing twice daily, one-week triple therapy with a proton pump inhibitor, clarithromycin (C) and amoxycillin (A) (PCA) vs. those using proton pump inhibitor, clarithromycin and a nitroimidazole (N) (PCN) for H. pylori eradication.
  
  
  METHODS
  
  
  
  METHODS
  Comparative randomized trials of PCA vs. PCN were included.
  
  
  METHODS
  PubMed database and abstracts from congresses until September 1999.
  
  
  METHODS
  Meta-analysis was performed combining the Odds Ratios (OR) of the individual studies in a global OR (Peto method) both on an intention-to-treat (ITT) and on a per protocol (PP) basis.
  
  
  RESULTS
  Twenty-two studies fulfilled the inclusion criteria. Eighteen studies reported ITT and 20 PP analysis. Mean H. pylori eradication rates were 81% (95% CI: 79-83%) ITT, and 84% (82-86%) PP with PCA, and 81% (78-83%) ITT and 84% (82-86%) PP with PCN; the odds ratio for the effect of PCA vs. PCN was 1 (0.83-1.22) on an ITT, and 0.98 (0.8-1.2) on a PP basis. Subanalysis showed that mean H. pylori eradication efficacy with PC(250 b.d.)A was 81% (78-85%) ITT, vs. 86% (83-89%) with PC(250 b.d.)N. The odds ratio for this comparison was 0.68 (0.48-0.98). Finally, when comparing PC(500 b.d. )A against PC(250 b.d.)N ITT cure rates were 77% (74-80%), and 75% (72-78%) with an odds ratio of 1.18 (0.93-1.5).
  
  
  CONCLUSIONS
  Overall, one-week combination regimens of PCA and PCN present similar H. pylori eradication efficacy. Nevertheless, the PCN regimen obtains significantly better results when using low doses of C (250 mg b.d.).
authors.affiliation: Department of Gastroenterology, University Hospital of La Princesa, Madrid, Spain. gisbert@meditex.es
authors.forename: J P
authors.initials: JP
authors.lastname: Gisbert
authors.forename: L
authors.initials: L
authors.lastname: González
authors.forename: X
authors.initials: X
authors.lastname: Calvet
authors.forename: N
authors.initials: N
authors.lastname: García
authors.forename: T
authors.initials: T
authors.lastname: López
authors.forename: M
authors.initials: M
authors.lastname: Roqué
authors.forename: R
authors.initials: R
authors.lastname: Gabriel
authors.forename: J M
authors.initials: JM
authors.lastname: Pajares
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use*; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D009593:Nitroimidazoles / Q000627:therapeutic use*; D010406:Penicillins / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors
chemical_list: D000900:Anti-Bacterial Agents; D004791:Enzyme Inhibitors; D009593:Nitroimidazoles; D010406:Penicillins; D054328:Proton Pump Inhibitors; D000658:Amoxicillin; D017291:Clarithromycin