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Updated: Feb 26, 2026
Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
Characterization of clarithromycin-resistant Helicobacter pylori strains in Iran: A systematic review and
Farzad Khademi1, Amir Hossein Sahebkar2, Hamid Vaez3
1Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
Background:
The high prevalence of clarithromycin-resistant strains of Helicobacter pylori is a main challenge for the successful treatment of gastrointestinal infections. Point mutations in the 23S rRNA gene are one of the main mechanisms leading to the resistance to clarithromycin in Iran. The purpose of the present review was to evaluate the prevalence of clarithromycin-resistant H. pylori strains in Iran and to identify the major molecular mechanisms of resistance in the resistant isolates.
Methods:
Using related keywords and computer search in English and Persian databases (up to November 21, 2016), available data about prevalence of clarithromycin-resistant H. pylori strains and molecular mechanisms of resistance in Iran were retrieved. Relevant articles were selected using pre-defined inclusion and exclusion criteria.
Results:
The results of the meta-analysis showed that the overall prevalence of clarithromycin-resistant H. pylori strains in Iran is 14.7%. The highest and the lowest resistance to clarithromycin were reported from Kashan (33.7%) and Rasht (5.5%), respectively. The most prevalent point mutations in Iran were A2143G (59.1%), A2142G (17.8%), A2142C (8.8%), and A2144G (6.2%), respectively.
Conclusion:
The prevalence of clarithromycin-resistant H. pylori strains was in an acceptable level in our region. Therefore, clarithromycin can be used for the eradication of H. pylori infection in Iran. However, it seems that investigation about the role of other mechanisms involved in the induction of resistance to clarithromycin is needed.
Insights
Clarithromycin resistance in Helicobacter pylori strains in Iran is 14.7%. Point mutations in the 23S rRNA gene are the primary cause, but clarithromycin remains viable for H. pylori eradication.
Area of Science:
- Microbiology
- Infectious Diseases
- Genetics
Background:
- High prevalence of clarithromycin-resistant Helicobacter pylori strains poses a challenge for gastrointestinal infection treatment.
- Point mutations in the 23S rRNA gene are a primary mechanism of clarithromycin resistance in H. pylori.
- Understanding resistance patterns is crucial for effective H. pylori infection management in Iran.
Purpose of the Study:
- To evaluate the prevalence of clarithromycin-resistant H. pylori strains in Iran.
- To identify the major molecular mechanisms contributing to clarithromycin resistance in H. pylori isolates.
Main Methods:
- A comprehensive literature search was conducted in English and Persian databases up to November 2016.
- Data on H. pylori resistance prevalence and molecular mechanisms in Iran were retrieved.
- Articles were selected based on predefined inclusion and exclusion criteria for meta-analysis.
Main Results:
- The overall prevalence of clarithromycin-resistant H. pylori in Iran was found to be 14.7%.
- Resistance varied geographically, with Kashan reporting the highest (33.7%) and Rasht the lowest (5.5%).
- The most common point mutations identified were A2143G (59.1%), A2142G (17.8%), A2142C (8.8%), and A2144G (6.2%).
Conclusions:
- The prevalence of clarithromycin-resistant H. pylori in Iran is at an acceptable level.
- Clarithromycin can still be considered for H. pylori eradication therapy in Iran.
- Further research is recommended to investigate other potential mechanisms of clarithromycin resistance.
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