Proton pump inhibitor, clarithromycin and either amoxycillin or nitroimidazole: a meta-analysis of eradication of Helicobacter pylori.
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.).
Gisbert
J P
JP
Department of Gastroenterology, University Hospital of La Princesa, Madrid, Spain. gisbert@meditex.es
González
L
L
Calvet
X
X
García
N
N
López
T
T
Roqué
M
M
Gabriel
R
R
Pajares
J M
JM
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
D000900:Anti-Bacterial Agents; D004791:Enzyme Inhibitors; D009593:Nitroimidazoles; D010406:Penicillins; D054328:Proton Pump Inhibitors; D000658:Amoxicillin; D017291:Clarithromycin