Premium
Helicobacter pylori antibiotic resistance in Portugal: Systematic review and meta‐analysis
Author(s) -
Lopo Inês,
Libânio Diogo,
Pita Inês,
DinisRibeiro Mário,
PimentelNunes Pedro
Publication year - 2018
Publication title -
helicobacter
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 79
eISSN - 1523-5378
pISSN - 1083-4389
DOI - 10.1111/hel.12493
Subject(s) - levofloxacin , amoxicillin , antibiotic resistance , medicine , antibiotics , helicobacter pylori , metronidazole , ciprofloxacin , drug resistance , tetracycline , clarithromycin , multiple drug resistance , gastroenterology , microbiology and biotechnology , biology
Background Portugal presents both a high prevalence of Helicobacter pylori (Hp) infection and a high prevalence of antibiotic resistance. However, conclusive data on its magnitude are lacking. We aimed at summarizing the existing data. Materials and Methods A systematic review was conducted after searching in two databases (PubMed and Sci ELO ). Meta‐analysis was performed, and comparison of resistance rates between children and adults and by type of resistance (primary and secondary) was made. Results Eight cross‐sectional studies assessing Hp resistance to antibiotics were included. Overall resistance rates were as follows: clarithromycin ( CLA ) 42% (95% CI : 30‐54), metronidazole ( MTZ ) 25% (95% CI : 15‐38), ciprofloxacin ( CIP ) 9% (95% CI : 3‐18), levofloxacin ( LVX ) 18% (95% CI : 2‐42), tetracycline ( TTC ) 0.2% (95% CI : 0‐1), and amoxicillin ( AMX ) 0.1% (95% CI : 0‐0.2). Multidrug resistance was also an important problem, with the following global resistance rates: CLA plus MTZ of 10% (adults 20% (95% CI : 15‐26) vs children 6% (95% CI : 4‐9)) and CLA plus CIP of 2% (primary resistance in children's group). High secondary resistance rates were found for all antibiotics. Resistance was higher among adults for all antibiotics, except CLA that had high resistance levels both among adults and children (42% 95% CI : 14‐71 and 40% 95% CI : 33‐47). Conclusions Hp resistance to the most widely used antibiotics is high in Portugal. Accordingly, our results suggest that the best therapeutic strategy for Hp in Portugal may be quadruple therapy with bismuth for adults and triple therapy including AMX plus MTZ or bismuth‐based therapy for children.