A systematic review 1 including 352 studies was abstracted in DARE.
Of dual therapies, omeprazole plus amoxycillin (121 studies, 5 725 patients) achieved an eradication rate of 59% (95% CI 58% to 61%) by intention to treat amalysis, and omeprazole plus clarithromycin (37 studies, 1 837 patients) achieved an eradication rate of 68% (95% CI 65-70%). In direct comparisons, eradication rates were higher for triple therapy than for dual therapy.
Standard triple therapy (bismuth plus nitroimidazole plus amoxycillin or tetracycline, 143 studies, 7 979 patients) achieved an eradication rate of 78% (95% CI 77% to 79%). Proton pump inhibitor therapy (79 studies, 5 513 patients) achieved an eradication rate of 86% (95% CI 85% to 87%). H2 receptor antagonist triple therapy (23 studies, 814 patients) achieved an eradication rate of 80% (95% CI 77% to 84%). There were higher eradication rates for omeprazole plus clarithromycin compared with omeprazole plus amoxycillin.
Another systematic review 2 including 666 studies with a total of 1 295 trials of 132 different medication combinations was abstracted in DARE. The most frequently investigated therapeutic regimen that provided sufficient effectiveness were triple therapies: two antimicrobial drugs supplemented by a proton pump inhibitor. A combination of the proton pump inhibitor plus macrolide plus nitroimidazole cured 87.1 and 82.9% of the patients per protocol and intention to treat analysis. Of the 2 macrolides evaluated, clarithromycin was superior to azithromycin. The dosage of clarithromycin incluenced cure rate: 1.5 g of clarithromycin cured H pylori in more patients than 500 mg, 600 mg, 750 mg or 1 g. The dosage of the other drugs did not influence the cure rate. The same antibiotics in combination with ranitidine bismuth subcitrate also performed well: 90.8% and 78.4% of patients were cured per protocol and on intention-to-treat basis. Overall cure rates of between 80% and 85% were achieved using combinations of proton pump inhibitor or ranitidine bismuth subcitrate with 2 antibiotics including clarithromycin, amoxycillin and metronidazole or tinidazole.
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