Helicobacter pylori Antibiotic Resistance in the United States Between 2011 and 2021: A Systematic Review and Meta-Analysis.
Amoxicillin
Anti-Bacterial Agents
/ pharmacology
Clarithromycin
Drug Resistance, Bacterial
Drug Resistance, Microbial
Helicobacter Infections
/ drug therapy
Helicobacter pylori
Humans
Levofloxacin
/ pharmacology
Metronidazole
/ pharmacology
Rifabutin
Tetracycline
/ pharmacology
United States
/ epidemiology
Journal
The American journal of gastroenterology
ISSN: 1572-0241
Titre abrégé: Am J Gastroenterol
Pays: United States
ID NLM: 0421030
Informations de publication
Date de publication:
01 08 2022
01 08 2022
Historique:
received:
23
01
2022
accepted:
29
04
2022
pubmed:
6
5
2022
medline:
9
8
2022
entrez:
5
5
2022
Statut:
ppublish
Résumé
Antimicrobial resistance among Helicobacter pylori strains has been rising globally, leading to declining eradication rates. We performed a systematic review and meta-analysis of the resistance patterns of H. pylori strains in the United States between 2011 and 2021. Ovid MEDLINE, Embase, CINAHL, and Cochrane CENTRAL databases were searched for manuscripts and conference abstracts published between 2011 and 2021 reporting H. pylori antibiotic resistance. A mixed-effects model estimated pooled rates of resistance to clarithromycin, amoxicillin, metronidazole, tetracycline, rifabutin, levofloxacin, or a combination of these, with 95% confidence intervals (CIs). A total of 19 studies including 2,660 samples, met inclusion criteria. The pooled rate of resistance to metronidazole was 42.1% (95% CI 27.3%-58.6%), levofloxacin 37.6% (95% CI 26.3%-50.4%), clarithromycin 31.5% (95% CI 23.6%-40.6%), amoxicillin 2.6% (95% CI 1.4%-5.0%), tetracycline 0.87% (95% CI 0.2%-3.8%), rifabutin 0.17% (95% CI 0.00%-10.9%), and dual clarithromycin and metronidazole 11.7% (95% CI 0.1%-94.0%). Considerable data heterogeneity was evident for pooled resistance prevalence rates (I 2 > 50%), with the exception of rifabutin resistance. Metronidazole, levofloxacin, and clarithromycin resistance rates each exceed 30%; thus, choosing an empiric antibiotic regimen without knowledge of the likely pattern of antibiotic resistance is not appropriate. Resistance to tetracycline, rifabutin, and amoxicillin remains low. Given the scarcity of available data with considerable heterogeneity among studies, continued surveillance, ideally with a more systematic approach to data collection, is an increasingly important goal in H. pylori management.
Identifiants
pubmed: 35509128
doi: 10.14309/ajg.0000000000001828
pii: 00000434-202208000-00016
doi:
Substances chimiques
Anti-Bacterial Agents
0
Metronidazole
140QMO216E
Rifabutin
1W306TDA6S
Levofloxacin
6GNT3Y5LMF
Amoxicillin
804826J2HU
Tetracycline
F8VB5M810T
Clarithromycin
H1250JIK0A
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1221-1230Informations de copyright
Copyright © 2022 by The American College of Gastroenterology.
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