Inês Lopo1, Diogo Libânio2, Inês Pita2, Mário Dinis-Ribeiro1,2, Pedro Pimentel-Nunes1,2,3. 1. Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal. 2. Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal. 3. Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.
Abstract
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 SciELO). 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.
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 SciELO). 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.
Authors: Adriana Motta-Raymundo; Pedro Rosmaninho; Diana F Santos; Ruben D Ferreira; Sara P Silva; Cristina Ferreira; Ana E Sousa; Susana L Silva Journal: Front Immunol Date: 2022-05-31 Impact factor: 8.786
Authors: André Mesquita; Carlos Rocha-Castro; Daniela Guimarães; Joana Costa; Joana Soutinho; Tiago Taveira-Gomes Journal: Int J Environ Res Public Health Date: 2022-10-07 Impact factor: 4.614