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The increasing antimicrobial resistance of Helicobacter pylori in Iran: A systematic review and meta-analysis
Mohammad Sholeh1, Farajolah Maleki2, Marcela Krutova3
1Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Background:
Antimicrobial resistance of Helicobacter pylori can result in eradication failure. Metadata on the antimicrobial resistance of H pylori in Iran could help to formulate H pylori eradication strategies in Iran.
Methods:
A systematic review was performed after searching in MEDLINE, Scopus, Embase, Web of Science, and the Cochrane Library. A meta-analysis was performed, and a comparison of the rates between children and adults; time periods (1999-2010, 2011-2016, 2017-2019); and the methods used was carried out.
Results:
A total of 66 studies investigating 5936 H pylori isolates were analyzed. The weighted pooled resistance (WPR) rates were as follows: clarithromycin 21% (95% CI 16-26), metronidazole 62% (95% 57-67), clarithromycin in combination with metronidazole 16% (95% CI 10-23), ciprofloxacin 24% (95% CI 15-33), levofloxacin 18% (95% CI 9-30), erythromycin 29% (95% CI 12-50), furazolidone 13% (95% CI 4-27), tetracycline 8% (95% CI 5-13), and amoxicillin 15% (95% CI 9-22). During the three time periods, there was an increased resistance to amoxicillin, clarithromycin, ciprofloxacin, furazolidone, and tetracycline (P ˂ .05). Furazolidone and a clarithromycin/metronidazole combination had the higher resistance rates in children (P ˂ .05).
Conclusion:
An increasing rate of resistance to amoxicillin, clarithromycin, ciprofloxacin, furazolidone, and tetracycline in Iranian H pylori isolates was identified. In children, the resistance to furazolidone and a combination of clarithromycin and metronidazole is higher compared to adults. As a stable, high resistance to metronidazole was found in children and adults in all Iranian provinces, we suggest that metronidazole should not be included in the Iranian H pylori eradication scheme.
Insights
Antimicrobial resistance in Helicobacter pylori is increasing in Iran, particularly to amoxicillin and clarithromycin. Metronidazole resistance is high and stable, suggesting its exclusion from H. pylori eradication regimens.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Antimicrobial resistance in Helicobacter pylori (H. pylori) is a significant cause of treatment failure.
- Understanding H. pylori resistance patterns in Iran is crucial for effective eradication strategies.
Purpose of the Study:
- To systematically review and meta-analyze antimicrobial resistance rates of H. pylori in Iran.
- To compare resistance trends across different age groups, time periods, and methodologies.
Main Methods:
- A comprehensive systematic review of multiple databases (MEDLINE, Scopus, Embase, Web of Science, Cochrane Library).
- Meta-analysis to determine weighted pooled resistance (WPR) rates for various antibiotics.
- Comparative analysis of resistance rates based on age, time intervals (1999-2019), and study methods.
Main Results:
- Analysis of 66 studies with 5936 H. pylori isolates.
- High pooled resistance rates observed for metronidazole (62%), ciprofloxacin (24%), and erythromycin (29%).
- Significant increasing trends in resistance to amoxicillin, clarithromycin, ciprofloxacin, furazolidone, and tetracycline were noted between 1999 and 2019.
Conclusions:
- Increasing resistance to key antibiotics (amoxicillin, clarithromycin, ciprofloxacin, furazolidone, tetracycline) in Iranian H. pylori isolates.
- Children exhibit higher resistance to furazolidone and clarithromycin/metronidazole combinations compared to adults.
- High and stable metronidazole resistance across all Iranian provinces suggests its removal from H. pylori eradication protocols.
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