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SYSTEMATIC REVIEW article

Front. Microbiol.
Sec. Infectious Agents and Disease
Volume 15 - 2024 | doi: 10.3389/fmicb.2024.1481763

Insights into Helicobacter pylori Macrolide Resistance: A Comprehensive Systematic Review and Meta-Analysis

Provisionally accepted
Mohammad Sholeh Mohammad Sholeh 1*Safoura Morad Kasani Safoura Morad Kasani 1Maryam Mofid Maryam Mofid 2Tahereh Navidifar Tahereh Navidifar 3Narges Golab Narges Golab 4Elnaz Parvizi Elnaz Parvizi 5Masoumeh Beig Masoumeh Beig 1*
  • 1 Department of Bacteriology, Pasteur Institute of Iran (PII), Tehran, Iran
  • 2 Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Hamadan, Iran
  • 3 Department of Basic Sciences, Shushtar School of Medical Sciences, Shoushtar, Iran
  • 4 Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Alborz, Iran
  • 5 Department of Microbiology, Science and Research Branch, Islamic Azad University, Fars, Iran, fars, Iran

The final, formatted version of the article will be published soon.

    Background: Helicobacter pylori infection is a primary global health concern. However, the widespread use of antibiotics, particularly macrolides such as clarithromycin, has increased resistance among H. pylori strains. This study aimed to investigate the prevalence of macrolide resistance in H. pylori in different world regions.Methods: This systematic literature search was performed using the appropriate search syntax after searching PubMed, Embase, Web of Science, and Scopus databases between May 2015 and December 2023. Statistical analysis was performed using Pooled and random effects model in R and the metafor package.Results: A total of 7768 articles were retrieved. After a thorough evaluation, 155 studies (by 178 reports) were finally eligible for inclusion in this systematic review and meta-analysis.According to the results, the majority of studies (178 reports from 43 countries) assessed clarithromycin susceptibility, with a pooled prevalence of 33.3% and high heterogeneity between studies (I² = 98.57%, p < 0.001). The rate of erythromycin resistance was moderate (22.8%, 10 reports), while azithromycin resistance was 34.4% (4 reports). Subgroup analysis revealed significant differences in the prevalence of resistance based on geographic location, continent, and year of publication. Clarithromycin resistance increased from 29.1% (2015-2019) to 36.5% (2020)(2021)(2022)(2023).Conclusions: This study highlights the critical challenges of macrolide resistance in treating H. pylori infection. The high prevalence and geographic variation underscore the need for tailored treatment strategies based on regional resistance patterns. Furthermore, continuously monitoring resistance trends and investigating contributing factors are essential to optimize treatment.

    Keywords: Helicobacter pylori, Clarithromycin, Erythromycin, Azithromycin, antibiotic resistance, Macrolides

    Received: 16 Aug 2024; Accepted: 10 Oct 2024.

    Copyright: © 2024 Sholeh, Morad Kasani, Mofid, Navidifar, Golab, Parvizi and Beig. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Mohammad Sholeh, Department of Bacteriology, Pasteur Institute of Iran (PII), Tehran, Iran
    Masoumeh Beig, Department of Bacteriology, Pasteur Institute of Iran (PII), Tehran, Iran

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.