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Global Profile of Drug Resistance Related to Helicobacter pylori Infection in Children: A Systematic Review and
Shaho Menbari1, Sara Kamal Shahsavar2,3, Masoud Keikha4,5
1Department of Pathology and Medical Laboratory Sciences, Faculty of Para Medicine Kurdistan University of Medical Sciences Sanandaj Iran.
Insights
Antibiotic resistance in pediatric Helicobacter pylori (H. pylori) is a growing concern. This meta-analysis found high resistance to clarithromycin and metronidazole in children globally, impacting treatment success.
Area of Science:
- Microbiology
- Pediatric Infectious Diseases
- Global Health
Background:
- Antibiotic-resistant Helicobacter pylori (H. pylori) strains impede eradication therapy in children and adults.
- Understanding primary antibiotic resistance in pediatric H. pylori is crucial for effective treatment strategies.
Purpose of the Study:
- To determine the global prevalence of primary antibiotic resistance in pediatric H. pylori isolates.
- To assess resistance patterns to key antibiotics used in H. pylori eradication.
Main Methods:
- Systematic literature search of major databases (PubMed, Scopus, Web of Science, Google Scholar) up to December 2021.
- Inclusion of studies reporting primary antibiotic resistance in H. pylori from pediatric populations worldwide.
- Meta-analysis of 111 studies involving 36,021 isolates using Comprehensive Meta-Analysis 2.2 software.
Main Results:
- High pooled resistance rates were observed for clarithromycin (25.6%) and metronidazole (30.9%) in pediatric H. pylori isolates.
- Low resistance rates were reported for amoxicillin (2.5%), tetracycline (2.0%), levofloxacin (12.1%), ciprofloxacin (6.9%), furazolidone (1.9%), nitrofurantoin (0.5%), and rifampin (9.1%).
- The pooled prevalence of multidrug-resistant H. pylori isolates in children was 4.5%.
Conclusions:
- Significant global burden of primary resistance to clarithromycin and metronidazole in pediatric H. pylori isolates.
- Resistance rates to amoxicillin, tetracycline, and fluoroquinolones remain low in this population.
- Therapeutic regimens including clarithromycin and metronidazole should be carefully considered, especially in regions with >20% resistance.
Background And Aims:
The increasing prevalence of antibiotic-resistant Helicobacter pylori (H. pylori) strains represents a critical impediment to successful eradication therapy in both pediatric and adult populations. This meta-analysis aimed to determine the current global landscape of primary antibiotic resistance in bacterial isolates obtained from children.
Methods:
A systematic literature search was conducted across ISI Web of Science, PubMed, Scopus, and Google Scholar, encompassing the period from the inception of each database up to December 2021. Eligible studies reporting primary antibiotic resistance in H. pylori isolates from children worldwide were included. Resistance rates were expressed as percentages with corresponding 95% confidence intervals. Statistical analysis was performed using Comprehensive Meta-Analysis 2.2.
Results:
One hundred eleven teens were included in this meta-analysis, and 36,021 isolates of this bacterium were evaluated. The resistance rate was reported 25.6%, 30.9%, 2.5%, 2.0%, 12.1%, 6.9%, 1.9%, 0.5%, and 9.1%, for clarithromycin, metronidazole, amoxicillin, tetracycline, levofloxacin, ciprofloxacin, furazolidone, nitrofurantoin, and rifampin respectively. Furthermore, the pooled prevalence of primary multidrug resistant isolates was 4.5%.
Conclusion:
This meta-analysis reveals a significant global burden of primary resistance to clarithromycin and metronidazole in pediatric H. pylori isolates, with evidence of increasing resistance over time. Conversely, resistance rates to amoxicillin, tetracycline, levofloxacin, ciprofloxacin, furazolidone, nitrofurantoin, and rifampin remained low. Consequently, therapeutic regimens incorporating clarithromycin and metronidazole should be carefully considered and potentially avoided in regions exhibiting resistance rates exceeding 20%.
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