Helicobacter pylori eradication: proton pump inhibitor vs. ranitidine bismuth citrate plus two antibiotics for 1 week - a meta-analysis of efficacy

Objective: To compare the efficacy of proton pump inhibitor vs. ranitidine bismuth citrate (RBC) with two antibiotics for 1 week in Helicobacter pylor i eradication. Methods: Randomized trials comparing 1-week regimens with (i ) proton pump inhibitor plus two antibiotics [clarithromycin (C) and amoxyc illin (A) or a nitroimidazole (N)]; or (ii) RBC plus the same antibiotics. Eradication was confirmed by histology or C-13-urea breath test at least 4 weeks after therapy. Data sources included PubMed database and abstracts fr om congresses until October 1999. Statistical analysis was by meta-analysis combining the odds ratios (OR) of the individual studies in a global OR (P eto method), Results: Twelve studies met the selection criteria, Nine compared proton pu mp inhibitor vs. RBC plus C and A, and five compared proton pump inhibitor vs. RBC plus C and N. With RBC, C and A, mean H, pylori eradication efficac y by intention-to-treat analysis (pooled data) was 76.6% (95% CI: 72-81%) a nd 73.7% (95% CI: 69-78%) with proton pump inhibitor, C and A. The OR for t he effect of RBC vs. proton pump inhibitor (plus C and A) on H. pylori erad ication was 1.15 (95% CI: 0.8-1.64%). Mean H, pylori eradication with RBC, C and N was 87.2% (95% CI: 83-91%), and 74.9% (95% CI: 74-84%) with proton pump inhibitor plus these two antibiotics, The OR for the effect of RBC vs. proton pump inhibitor (plus C and N) on H, pylori eradication was 1.76 (95 % CI: 1.08-2.85%). Conclusion: RBC and proton pump inhibitor have similar efficacy for H, pylo ri eradication when given with C and A for 1 week, but RBC seems to have a higher efficacy than proton pump inhibitor when C and N are the co-prescrib ed antibiotics.