Global Profile of Drug Resistance Related to <i>Helicobacter pylori</i> Infection in Children: A Systematic Review and Meta-Analysis.

Abstract

<h4>Background and aims</h4>The increasing prevalence of antibiotic-resistant <i>Helicobacter pylori</i> (<i>H. pylori</i>) strains represents a critical ‎impediment to successful eradication therapy in both pediatric and adult populations. This ‎meta-analysis aimed to determine the current global landscape of primary antibiotic resistance ‎in bacterial isolates obtained from children.<h4>Methods</h4>A systematic literature search was conducted across ISI Web of Science, PubMed, Scopus, ‎and Google Scholar, encompassing the period from the inception of each database up to ‎December 2021. Eligible studies reporting primary antibiotic resistance in <i>H. pylori</i> isolates ‎from children worldwide were included. Resistance rates were expressed as percentages with ‎corresponding 95% confidence intervals. Statistical analysis was performed using ‎Comprehensive Meta-Analysis 2.2.<h4>Results</h4>One hundred eleven teens were included in this meta-analysis, and 36,021 isolates of this bacterium were evaluated. The resistance rate was reported 25.6%, 30.9%, 2.5%, 2.0%, 12.1%, 6.9%, 1.9%, 0.5%, and 9.1%, for clarithromycin, metronidazole, amoxicillin, tetracycline, levofloxacin, ciprofloxacin, furazolidone, nitrofurantoin, and rifampin respectively. Furthermore, the pooled prevalence of primary multidrug resistant isolates was 4.5%.<h4>Conclusion</h4>This meta-analysis reveals a significant global burden of primary resistance to clarithromycin ‎and metronidazole in pediatric <i>H. pylori</i> isolates, with evidence of increasing resistance over ‎time. Conversely, resistance rates to amoxicillin, tetracycline, levofloxacin, ciprofloxacin, ‎furazolidone, nitrofurantoin, and rifampin remained low. Consequently, therapeutic regimens ‎incorporating clarithromycin and metronidazole should be carefully considered and ‎potentially avoided in regions exhibiting resistance rates exceeding 20%.