Proton pump inhibitor, clarithromycin and either amoxycillin or nitroimidazole: a meta-analysis of eradication of Helicobacter pylori

Aim: To perform a meta-analysis of studies comparing twice daily, one-week triple therapy with a proton pump inhibitor, clarithromycin (C) and amoxyci llin (A) (PCA) vs. those using proton pump inhibitor, clarithromycin and a nitroimidazole (N) (PCN) for H. pylori eradication. Review methods: Selection criteria: Comparative randomized trials of PCA vs . PCN were included. Data sources: PubMed database and abstracts from congr esses until September 1999. Statistics: Meta-analysis was performed combini ng the Odds Ratios (OR) of the individual studies in a global OR (Peto meth od) both on an intention-to-treat (ITT) and on a per protocol (PP) basis. Results: Twenty-two studies fulfilled the inclusion criteria. Eighteen stud ies 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%) IT T and 84% (82-86%) PP with PCN; the odds ratio for the effect of PCA vs. PC N was 1 (0.83-1.22) on an ITT, and 0.98 (0.8-1.2) on a PP basis. Subanalysi s 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 thi s comparison was 0.68 (0.48-0.98). Finally, when comparing PC(500 b.d.)A ag ainst 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). Conclusion: Overall, one-week combination regimens of PCA and PCN present s imilar H. pylori eradication efficacy. Nevertheless, the PCN regimen obtain s significantly better results when using low doses of C (250 mg b.d.).