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Meta-Analysis
. 2024 Dec 23;22(1):598.
doi: 10.1186/s12916-024-03816-y.

Global prevalence of Helicobacter pylori antibiotic resistance among children in the world health organization regions between 2000 and 2023: a systematic review and meta-analysis

Aryan Salahi-Niri  1 , Ali Nabavi-Rad  1 , Tanya Marie Monaghan  2   3 , Theodore Rokkas  4   5 , Michael Doulberis  6   7 , Amir Sadeghi  8 , Mohammad Reza Zali  8 , Yoshio Yamaoka  9   10   11 , Evelina Tacconelli  12 , Abbas Yadegar  13   14
Affiliations
Meta-Analysis

Global prevalence of Helicobacter pylori antibiotic resistance among children in the world health organization regions between 2000 and 2023: a systematic review and meta-analysis

Aryan Salahi-Niri et al. BMC Med. .

Abstract

Background: Helicobacter pylori infection causes gastritis, peptic ulcers, and gastric cancer. The infection is typically acquired in childhood and persists throughout life. The major impediment to successful therapy is antibiotic resistance. This systematic review and meta-analysis aimed to comprehensively assess the global prevalence of antibiotic resistance in pediatric H. pylori infection.

Methods: We performed a systematic search of publication databases that assessed H. pylori resistance rates to clarithromycin, metronidazole, levofloxacin, amoxicillin, and tetracycline in children. The WHO region classification was used to group pooled primary and secondary resistance estimates along with 95% confidence interval (CI). H. pylori antibiotic resistance rates were retrieved and combined with odds ratios (95% CI) to investigate the global prevalence and temporal trends. Subgroup analysis of the prevalence of antibiotic resistance was conducted by country, age groups, and susceptibility testing methods.

Results: Among 1417 records obtained initially, 152 studies were selected for eligibility assessment after applying exclusion criteria in multiple steps. Ultimately, 63 studies involving 15,953 individuals were included comprising data from 28 countries in 5 WHO regions. The primary resistance rates were metronidazole 35.3% (5482/15,529, 95% CI: 28.7-42.6), clarithromycin 32.6% (5071/15,555, 95% CI: 27.7-37.9), tetracycline 2.1% (148/7033, 95% CI: 1.3-3.6), levofloxacin 13.2% (1091/8271, 95% CI: 9.3-18.4), and amoxicillin 4.8% (495/10305, 95% CI: 2.5-8.8). Raising antibiotic resistance was detected in most WHO regions.

Conclusions: The escalating trend of H. pylori antibiotic resistance in children warrants urgent attention globally. National and regional surveillance networks are required for antibiotic stewardship in children infected with H. pylori.

Keywords: Helicobacter pylori; Antibiotic resistance; Children; Epidemiology; Meta-analysis; WHO region.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable; this manuscript does not include any details, images, or videos relating to an individual person. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study selection process
Fig. 2
Fig. 2
The trends of resistance status of H. pylori in specified time intervals for clarithromycin and metronidazole (A), and for amoxicillin and tetracycline (B) are presented in separate lines. Error bars represent 95% CIs
Fig. 3
Fig. 3
Estimated pooled prevalence of antibiotic resistance for amoxicillin (A), metronidazole (B), and clarithromycin (C) of H. pylori among children from 28 countries in 5 WHO regions during (2000–2023) (created with mapchart.net)
See this image and copyright information in PMC

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