Antibiotic resistance in Helicobacter pylori among children and adolescents in East Asia: A systematic review and meta-analysis

Abstract

Background: In East Asia, Helicobacter pylori ( H. pylori ) infection and related diseases are common, primarily during childhood and adolescence. The rates of primary antibiotic resistance in H. pylori among East Asian children and adolescents have not been extensively explored; few relevant systematic reviews or meta-analyses have been conducted. We evaluated the rates of antibiotic resistance in H. pylori among East Asian children and adolescents, with the goal of facilitating individualized treatment recommendations.

Methods: We searched PubMed, Embase, and the Cochrane Library for studies in any language published up to February 2023 that explored antibiotic resistance in H. pylori among East Asian children and adolescents. We used MeSH and non-MeSH terms related to the topic, including terms related to children, adolescents, antibiotic resistance, H. pylori , and nations or regions. Additionally, we reviewed the reference lists of relevant articles. Studies that matched our strict predefined eligibility criteria were included in the screening process. Using established assessment methods, we evaluated the quality of the included studies.

Results: We identified 15 observational studies involving 4831 H. pylori isolates, all published between 2001 and 2022. There was substantial primary antibiotic resistance in H. pylori isolates from East Asian children and adolescents. The rates of primary resistance were 51% (95% confidence interval [CI]: 40-62%) for metronidazole; 37% (95% CI: 20-53%) for clarithromycin; 19% (95% CI: 11-28%) for levofloxacin; and less than 3% each for amoxicillin, tetracycline, and furazolidone. Subgroup analysis revealed a prominent increase in metronidazole resistance over time. Clarithromycin and levofloxacin resistance rates fluctuated between 2005 and 2015, then remained stable; other antibiotic resistance rates were generally stable. Metronidazole, clarithromycin, and levofloxacin resistance rates were significantly higher in the Chinese mainland than in other East Asian regions. The rates of dual and multiple antibiotic resistance were 28% (95% CI: 21-36%) and 10% (95% CI: 7-14%), highlighting the potential for diverse resistance patterns.

Conclusions: H. pylori isolates from East Asian children and adolescents exhibit high levels of metronidazole and clarithromycin resistance, particularly in the Chinese mainland. The non-negligible rates of dual and multiple resistance highlight the complexity of this problem.

Registration: PROSPERO, No. CRD42023402510.

Figure 1

Flow diagram of the study selection process.

Figure 2

Rates of H. pylori resistance to metronidazole. (A) Forest plot of metronidazole resistance rate. (B) Metronidazole resistance over time. (C) Metronidazole resistance according to region: the Chinese mainland and other regions. (D) Metronidazole resistance according to geographic regions. (E) Metronidazole resistance according to detection method. CI: Confidence interval.

Figure 3

Rates of H. pylori resistance to clarithromycin. (A) Forest plot of clarithromycin resistance rate. (B) Clarithromycin resistance over time. (C) Clarithromycin resistance according to region: the Chinese mainland and other regions. (D) Metronidazole resistance according to geographic regions. (E) Clarithromycin resistance according to detection method. CI: Confidence interval. NA: Not applicable.

Figure 4

Rates of H. pylori resistance to levofloxacin. (A) Forest plot of levofloxacin resistance rate. (B) Levofloxacin resistance over time. (C) Levofloxacin resistance according to geographic regions. (D) Galbraith plot of levofloxacin resistance rate. CI: Confidence interval.