Primary antibiotic resistance of Helicobacter pylori in India over the past two decades: A systematic review

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2024-02-28 DOI:10.1111/hel.13057

Spriha Dutta, Surbhi Jain, Kunal Das, Prashant Verma, Anup Som, Rajashree Das

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Abstract

Background

Helicobacter pylori antibiotic resistance has undergone vast changes in the last two decades. No systematic review has been done on the prevalence of antibiotic resistant H. pylori in India in the last two decades. We evaluated the pattern of resistance rates across various regions of India.

Materials and Methods

A systematic review of the geographical variations in antibiotic resistance pattern of H. pylori was conducted using PubMed, Google Scholar, Web of Science, Science Direct, etc. for articles published between January 1, 2000 and May 30, 2023. Random effects-model-based Cochran's Q test, I² statistics, and chi-squared tests were used to measure heterogeneity.

Results

The overall resistance was highest against metronidazole (77.65%) followed by amoxicillin (37.78%), levofloxacin (32.8%), clarithromycin (35.64%), furazolidone (12.03%), and tetracycline (11.63%). 14.7% of the H. pylori isolates were multi-drug resistant. Under meta-analysis of each antibiotic, high heterogeneity levels were observed having I² ranges from 86.53% to 97.70% at p < 0.0001. In sub-group analysis, Metronidazole has a stable rate of resistance as compared to other antibiotics. Other antibiotics have had a downtrend in the last 5 years except for levofloxacin, which has had an uptrend in the resistance rate for the past 5 years. Hence, one should avoid using metronidazole for any kind of first-line treatment.

Conclusions

Metronidazole resistance is high in most regions of India except Assam and Mumbai while clarithromycin is found to be ineffective in South India, Gujarat, and Kashmir. As compared to other antibiotics, resistance to amoxicillin is generally low except in certain regions (Hyderabad, Chennai, and the Gangetic belt of North India). Tetracycline and Furazolidone have the least resistance rates and should be part of anti- H. pylori regimens. The resurgence of high single and multidrug resistance to the commonly used drugs suggests the need for newer antibiotics and regular resistance surveillance studies.

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过去二十年印度幽门螺杆菌的原发性抗生素耐药性：系统回顾。

背景：幽门螺杆菌的抗生素耐药性在过去二十年间发生了巨大变化。在过去二十年中，尚未对印度幽门螺杆菌的耐药性流行情况进行过系统回顾。我们评估了印度不同地区的耐药率模式：我们使用 PubMed、Google Scholar、Web of Science、Science Direct 等网站，对 2000 年 1 月 1 日至 2023 年 5 月 30 日期间发表的文章进行了系统综述，研究了幽门螺杆菌抗生素耐药模式的地域差异。采用基于随机效应模型的科克兰Q检验、I2统计量和卡方检验来衡量异质性：甲硝唑的耐药性最高（77.65%），其次是阿莫西林（37.78%）、左氧氟沙星（32.8%）、克拉霉素（35.64%）、呋喃唑酮（12.03%）和四环素（11.63%）。14.7%的幽门螺杆菌分离物具有多重耐药性。在对每种抗生素进行荟萃分析时，观察到了较高的异质性水平，其 I2 范围为 86.53% 至 97.70%，P 值为结论：除阿萨姆邦和孟买外，印度大部分地区对甲硝唑的耐药性都很高，而克拉霉素在南印度、古吉拉特邦和克什米尔则无效。与其他抗生素相比，除了某些地区（海得拉巴、钦奈和北印度恒河带）外，阿莫西林的耐药性普遍较低。四环素和呋喃唑酮的耐药率最低，应作为抗幽门螺杆菌方案的一部分。对常用药物的高单药耐药性和多药耐药性的再次出现表明，有必要采用更新的抗生素并定期进行耐药性监测研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

期刊介绍： Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.