The effect of antibiotic resistance on Helicobacter pylori eradication efficacy: A systematic review and meta‐analysis

Abstract

BackgroundThe occurrence of antibiotic‐resistant strains has been rapidly increasing due to the wide use of antibiotics. To evaluate the current effects of antibiotic resistance on Helicobacter pylori eradication efficacy, we conducted this systematic review and meta‐analysis.MethodsLiterature searches were conducted in the following databases: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Statistical analysis was performed using STATA version 12.0 (StataCorp LP, College Station, TX, USA).ResultsA total of 120 studies, including 28 707 patients, were assessed. Only first‐line therapy was considered. The pooled RR of eradication rate in patients with Helicobacter pylori strains sensitive versus resistant to clarithromycin was 0.682 (95% CI: 0.636‐0.731). The pooled RR of eradication rate in patients with Helicobacter pylori strains sensitive versus resistant to metronidazole was 0.843 (95% CI: 0.810‐0.877). The pooled RR of eradication rate in patients with Helicobacter pylori strains sensitive versus resistant to levofloxacin was 0.794 (95% CI: 0.669‐0.941). The pooled RR of eradication rate in patients with Helicobacter pylori strains sensitive versus resistant to dual clarithromycin and metronidazole was 0.674 (95% CI: 0.590‐0.770).ConclusionAntibiotic resistance causes a decrease in the eradication rate of H pylori today. Quadruple concomitant therapy may overcome the declining H pylori eradication rate caused by metronidazole‐only resistance.

Synergistic Therapies as a Promising Option for the Treatment of Antibiotic-Resistant Helicobacter pylori

“…Probiotics, although helpful in alleviating negative symptoms associated with H. pylori antibiotic therapies, when used as a monotherapy have a low curability rate [ 16 ]. This has contributed to the situation in which antibiotics are the only accepted form of combating H. pylori , which in turn conditions the growing resistance of this microorganism to these medications [ 17 ]. The aforementioned phenomenon is exacerbated additionally by the narrow spectrum of antibiotics that are used to treat H. pylori infections (amoxicillin [AMX], clarithromycin [CLR], tetracycline [TET], metronidazole [MTZ], levofloxacin [LEV], and rifabutin [RIF]) [ 6 , 7 , 18 ].…”

Helicobacter pylori Primary and Secondary Genotypic Resistance to Clarithromycin and Levofloxacin Detection in Stools: A 4-Year Scenario in Southern Italy

“…However, since the use of fluoroquinolones has spread for urinary and respiratory infection, and considering that cross-resistance among fluoroquinolones may occur, a rapid rise in resistance to levofloxacin has taken place, with rates close to 40% in some reports [ 11 ]. This rise may have a relevant impact on eradication rates: a meta-analysis showed that successful eradication was achieved in 91.5% of sensitive strains and only 75% of resistant strains [ 12 ]. For levofloxacin, mutations in the gyrase A ( gyrA ) gene are responsible for antibiotic resistance [ 6 ].…”

Identifying the best regimen for primary eradication of Helicobacter pylori: analysis of 240 cases

“…The acquisition of antibiotic resistance is the most common cause of eradication failure (Zou et al, 2020). In China, the rate of H .…”

“…The acquisition of antibiotic resistance is the most common cause of eradication failure (Zou et al, 2020). In China, the rate of H. pylori resistance to different antibiotics is generally high, with a clear difference among regions and populations (Ji et al, 2016;Liu et al, 2019;Tong et al, 2015;Zhang et al, 2015).…”