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Background  There has been an increasing resistance rate to tetracyclines, the first line treatment for cholera disease caused by  V. cholera  strains, worldwide. The aim of the present study was to determine the global status of resistance to this class of antibiotic among  V. cholera  isolates.    Methods  For the study, electronic databases were searched using the appropriate keywords including: ‘ Vibrio ’, ‘ cholera ’, ‘ Vibrio cholerae ’, ‘ V. cholerae ’, ‘resistance’, ‘antibiotic resistance’, ‘antibiotic susceptibility’, ‘antimicrobial resistance’, ‘antimicrobial susceptibility’, ‘tetracycline’, and ‘doxycycline’. Finally, after some exclusion, 52 studies from different countries were selected and included in the study and meta-analysis was performed on the collected data.    Results  The average resistance rate for serogroup O1 to tetracycline and doxycycline was 50% and 28%, respectively (95% CI). A high level of heterogeneity ( I  2  > 50%,  p -value < 0.05) was observed in the studies representing resistance to tetracycline and doxycycline in O1 and non-O1, non-O139 serogroups. The Begg’s tests did not indicate the publication bias ( p -value > 0.05). However, the Egger’s tests showed some evidence of publication bias in the studies conducted on serogroup O1.Conclusions  The results of the present study show that the overall resistance to tetracyclines is relatively high and prevalent among  V. cholerae  isolates, throughout the world. This highlights the necessity of performing standard antimicrobial susceptibility testing prior to treatment choice along with monitoring and management of antibiotic resistance patterns of  V. cholerae  strains in order to reduce the emergence and propagation of antibiotic resistant strains as well as the failure of treatment.

Global status of tetracycline resistance among clinical isolates of Vibrio cholerae: a systematic review and meta-analysis