The prevalence of clarithromycin-resistant Helicobacter pylori isolates: a systematic review and meta-analysis

Abstract

Background Knowledge of global clarithromycin (CLA)-resistant rates of Helicobacter pylori (H. pylori) is crucial for decision of the most appropriate eradication therapies with good clinical outcomes. Therefore, this review and meta-analysis aimed to evaluate the global prevalence of the CLA resistance in H. pylori to provide some guidance for selecting the first-line antibiotics. Method A comprehensive search was performed for relevant literature until April 2021 in PubMed, Embase, and Web of Science databases. Freeman-Tukey double arcsine transformation was performed to estimate the weighted pooled prevalence of resistance. Results The meta-analysis included 248 articles. The prevalence of CLA-resistant H. pylori was 27.53% (95% CI [25.41–29.69]). The heterogeneity between reports was significant (I2 = 97.80%, P < 0.01). The resistance rate increased from 24.28% in 2010–2017 to 32.14% in 2018–2021 (P < 0.01). Iran, with 38 articles, has the most report. Nevertheless, Switzerland, Portugal, and Israel had the highest resistance rates (67.16%, 48.11%, and 46.12%, respectively). The heterogeneity between the continents and the antimicrobial susceptibility methods also interpreted standard guidelines and breakpoints was insignificant (P > 0.05). Conclusion Overall CLA resistance rate was 27.53%, worldwide. The difference in CLA resistance rate among the included studies can be due to several reasons such as differences in antibiotic prescription rates in various geographic areas, use of different breakpoints or inaccurate criteria in performed studies, and the emergence of multidrug-resistant (MDR) strains.

A reconstructed genome‐scale metabolic model of Helicobacter pylori for predicting putative drug targets in clarithromycin and rifampicin resistance conditions

“…Studies have reported an increase in resistance to clarithromycin and rifampicin in H. pylori over the past decades. [57][58][59][60] Concerning clarithromycin and rifampicin resistance, we further visualized the metabolic differences between H. pylori-sensitive and -resistant strains to these antibiotics. This was achieved by generating GSMMs for each strain and performing a comprehensive survey of pathway analysis.…”

Antibiotic susceptibility pattern of Helicobacter pylori against eight antibiotics: A study from North India

“…[ 10,14,26 ] High levels of CLA resistance may stem from several factors including the unregulated prescription of CLA and the utilization of CLA in treating other infections like respiratory tract infections or intestinal parasite infections. [ 34 ]…”

Polymorphism of virulence genes and biofilm associated with in vitro induced resistance to clarithromycin in Helicobacter pylori

“…The global resistance rate of clarithromycin increased significantly from 24.28% in 2010–2017 to 32.14% in 2018–2021 with Switzerland, Portugal, and Israel having the highest resistance rate [ 25 ]. Similarly, clarithromycin resistance in Malaysia is also increasing from 6.8% between July 2011 and August 2012 [ 26 ] to 35.6% between April 2014 and August 2015 [ 27 ].…”