The Emergence of Multidrug-Resistant Helicobacter pylori in Southeast Asia: A Systematic Review on the Trends and Intervention Strategies Using Antimicrobial Peptides

Abstract

The emergence of multidrug-resistant H. pylori poses a public healthcare threat, particularly in low- and middle-income countries. Recently, the World Health Organization has classified clarithromycin-resistant H. pylori as high priority in the research and discovery of novel antibiotics. This study was aimed to systematically review the prevalence of primary antibiotic resistance in H. pylori in Southeast Asian countries (SEAC) and to review current studies of antimicrobial peptides against H. pylori. We systematically searched through electronic databases of studies conducted on antimicrobial resistance of H. pylori in SEA countries. Furthermore, we searched articles that conducted studies on antimicrobial peptides, naturally occurring host's defense molecules, against H. pylori. After a series of screening processes, 15 studies were included in our systematic review. Our analysis revealed that primary resistance of H. pylori to metronidazole, clarithromycin, and levofloxacin were high in SEAC, although the primary resistance to amoxicillin and tetracycline remains low. Multidrug-resistant H. pylori are emerging in SE Asian countries. The antimicrobial peptides show promising antibacterial and antibiofilm activity against drug-resistant H. pylori. The research and discovery of antimicrobial peptides against H. pylori in SEAC will help in limiting the spread of antimicrobial resistance of H. pylori.

Keywords: Helicobacter pylori; antimicrobial peptides; antimicrobial resistance; clarithromycin; low and middle-income countries; metronidazole; multidrug resistance.

Figure 1

Flow chart of study selection. Exclusion criteria were: (1) Studies that measured the prevalence of alternative antibiotics for H. pylori treatment, (2) studies that reported prevalence results using < 50 isolates for culture method or <50 H. pylori positive gastric biopsies for nucleic acid-based method, (3) studies that only reported percentage of resistance rates with no description of the number of isolates used, (4) studies with no time frame of sample collection, (5) studies that clustered prevalence rates data more than three years, (6) studies that failed to state the percentage of primary antibiotic resistance in H. pylori isolates examined, and (7) studies that only examined the prevalence of resistance rate of secondary isolates.