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Meta-Analysis
. 2025 Apr 12;14(1):31.
doi: 10.1186/s13756-025-01533-6.

Clarithromycin-resistant Helicobacter pylori in Africa: a systematic review and meta-analysis

Komla Mawunyo Dossouvi  1 , Tchilabalo Bouyo  2 , Simon Sognonnou  3 , Ephraim Ehidiamen Ibadin  4 , Lu-Chao Lv  5 , Bissoume Sambe Ba  6 , Abdoulaye Seck  7 , Sika Dossim  8 , Fábio Parra Sellera  9   10 , Makhtar Camara  11 , Amr El Kelish  12   13 , Stella Ifeanyi Smith  14   15
Affiliations
Meta-Analysis

Clarithromycin-resistant Helicobacter pylori in Africa: a systematic review and meta-analysis

Komla Mawunyo Dossouvi et al. Antimicrob Resist Infect Control. .

Abstract

Background: In 2022, approximately 56.5% of adults and 47.1% of children and adolescents were affected by Helicobacter pylori (H. pylori) infection in Africa, and clarithromycin-resistant H. pylori (CRHp) strains have become global priority pathogens. Therefore, this study aimed to conduct the first comprehensive systematic review and meta-analysis of CRHp in Africa.

Methods: This investigation was conducted according to the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (The PRISMA 2020). Literature search of electronic databases (Google Scholar, African Journals Online, ResearchGate, PubMed, Embase, and Scopus) was performed using keywords "clarithromycin", "Helicobacter pylori", "African country name", "mutation in the 23S rRNA".

Results: Sixty-five studies involving 5,313 H. pylori strains isolated over 26 years (1997-2022) from 23 African countries were included in this study. The samples from which CRHp was isolated included gastric biopsy (60/63; 95%), and stool (4/63; 6%). The pooled prevalence of CRHp in Africa was 27% (95% CI: 22, 33). There was a steady trend in the prevalence of CRHp isolated in Africa over the 26 years (R2 = 0.0001, p = 0.92, slope coefficient of -0.05x). Ten types of 23S rRNA mutations (conferring clarithromycin resistance) were identified, and included mainly A2143G (465 H. pylori strains out of 1178 tested) and A2142G (344 H. pylori strains out of 1027).

Conclusion: To enhance the accuracy and validity of surveillance data for H. pylori in Africa, there is an urgent need for implementing standardized microbiological methods for resistance detection. The prevalence of CRHp reported in this study was very similar to the overall global prevalence and there is a need for more representative studies on CRHp in Africa. While waiting for this, the treatment of H. pylori infections must be based on the guidelines of the AHMSG first Lagos consensus.

Keywords: Helicobacter pylori; Antimicrobial resistance in Africa; Clarithromycin resistance; Global priority pathogens; Meta-analysis; Systematic review.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA search flow diagram
Fig. 2
Fig. 2
Map of Africa showing the number of study on CRHp in Africa
See this image and copyright information in PMC

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