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The magnitude of antibiotic resistance to Helicobacter pylori in Africa and identified mutations which confer resistance to antibiotics: systematic review and meta-analysis
Gastroenterology and Hepatology Unit, Weill Bugando School of Medicine, Catholic University of Heath and Allied Sciences and Bugando Hospital Mwanza, Mwanza, Tanzania.
Weill Cornell Medicine-Qatar, Doha, Qatar.
National Medical Library, United Arab Emirates University, Abu Dhabi, United Arab Emirates.ORCID iD: 0000-0001-5091-604X
Cincinnati Children’s Hospital Medical Centre, Cincinnati Ohio, USA.ORCID iD: 0000-0003-4083-0060
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2018 (English)In: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 18, article id 193Article, review/survey (Refereed) Published
Abstract [en]

Background: Worldwide Helicobacter pylori (H. pylori) treatment is of great challenge due to increased antibiotic resistance. The burden of H. pylori antibiotic resistance in Africa is high with unclear information regarding the real magnitude. This systematic review and meta-analysis was conducted to investigate the magnitude of H. pylori antibiotic resistance in Africa to gain insight of the extent of the problem among H. pylori naive treatment patients.

Method: The search was performed in the academic databases, Embase, PubMed, Web of Science and Africa Wide Information. ProQuest Dissertation and Theses, Scopus, Ethos, Africa Index Medicus (WHO), BioMed Central Proceedings, BASE, British Library, Open grey, Library of Congress and the New York Academy of Grey Literature Report were additionally searched for grey literature. Published articles from Africa on H. pylori antibiotic resistance between 1986 and June 2017 were systematically reviewed to estimate the H. pylori extent of resistance to macrolides, quinolones, amoxicillin, tetracycline and metronidazole.

Results: In 26 articles a total of 2085 isolates were tested for metronidazole, 1530 for amoxicillin, 1277 for tetracycline, 1752 for clarithromycin and 823 for quinolones. The overall pooled proportion of H. pylori resistance to quinolones, clarithromycin, tetracycline, metronidazole and amoxicillin were: (17.4%, 95% CI 12.8-21.9), (29.2%, 95% CI: 26.7-31.8), (48.7%, 95% CI: 44.5-52.9), (75.8%, 95% CI: 74.1-.77.4) and (72.6%, 95% CI: 68.6-76.6), respectively. The commonest mutation detected were A2143G (49/97) for clarithromycin, RdxA (41/56) for metronidazole and D87I (16/40) for quinolones.

Conclusion: Prevalence of metronidazole, clarithromycin, and amoxicillin resistance is high in developing world including Africa. This could impair the first line triple therapy of the H. pylori infection. There is a need of conducting surveillance of H. pylori susceptibility pattern in Africa for dual and triple resistance which can be used for the empirical treatment.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2018. Vol. 18, article id 193
Keywords [en]
H. Pylori, Drug resistance, Antibiotics resistance, Clarithromycin, Metronidazole, Quinolones, Africa
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:oru:diva-105496DOI: 10.1186/s12879-018-3099-4ISI: 000431055700002PubMedID: 29699490Scopus ID: 2-s2.0-85046028578OAI: oai:DiVA.org:oru-105496DiVA, id: diva2:1750474
Available from: 2023-04-13 Created: 2023-04-13 Last updated: 2024-01-17Bibliographically approved

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