An exact unconditional method for the design and analysis of the 2 x 2 matched-pairs trial is presented. Unlike the exact conditional method, which is based on only the number of discordant pairs, the exact unconditional method uses the total number N of sampled pairs. This unconditional test, based on a simple Z statistic, yields sample sizes that are generally smaller than those produced by the exact conditional test for the cases tabulated herein, namely one-sided alpha = .01, .025, and .05 along with 80% and 90% power. Moreover, it is found to be uniformly more powerful than the latter for all the combinations of parameters considered in this paper, namely alpha = .01, .025, and .05, and N = 10(1)200. The method is illustrated by assessing various design options of an in vitro study of the effectiveness of antimicrobial agents. Some numerical examples of matching efficiency are also given.