U.S. antibiotic resistance rates for H. pylori appear high
A systematic review and meta-analysis of resistance patterns of Helicobacter pylori strains found that resistance to metronidazole, levofloxacin, and clarithromycin exceeds 30%.
Antibiotic resistance patterns of Helicobacter pylori in the United States are high, and more complete data are vital, according to a recent systematic review and meta-analysis.
Researchers searched the literature for studies that were published between 2011 and 2021 and reported H. pylori antibiotic resistance. They used a mixed-effects model to estimate pooled rates of resistance to clarithromycin, amoxicillin, metronidazole, tetracycline, rifabutin, levofloxacin, or combination regimens. The results were published May 5 by the American Journal of Gastroenterology.
Nineteen studies including 3,661 patients met the inclusion criteria. Overall, 2,669 H. pylori strains were analyzed. The researchers found that the pooled rate of resistance was 42.1% (95% CI, 27.3% to 58.6%) for metronidazole, 37.6% (95% CI, 26.3% to 50.4%) for levofloxacin, 31.5% (95% CI, 23.6% to 40.6%) for clarithromycin, 2.6% (95% CI, 1.4% to 5.0%) for amoxicillin, 0.87% (95% CI, 0.2% to 3.8%) for tetracycline, 0.17% (95% CI, 0.00% to 10.9%) for rifabutin, and 11.7% (95% CI, 0.1% to 94.0%) for dual therapy with clarithromycin and metronidazole. Considerable heterogeneity was seen in the data for pooled rates of resistance prevalence for all regimens except rifabutin.
The authors noted that the available data on resistance prevalence in the U.S. are sparse and that the precision of their estimates should therefore be interpreted with caution. They stressed that the current U.S. approach to H. pylori eradication is suboptimal and based on very limited knowledge of success rates and resistance profiles and added that a large prospective national U.S. registry is greatly needed. The usual resistance threshold for avoiding a particular regimen is 15%, the authors said, and metronidazole, levofloxacin, and clarithromycin all exceeded 30% in this study.
“Choosing an empiric antibiotic regimen without knowledge of the likely pattern of antibiotic resistance is not appropriate for the management of any infectious disease,” the authors wrote. “Clinicians should routinely test for cure in order to monitor their own eradication rates and, if suboptimal, use resistance testing to establish local patterns of antimicrobial susceptibility from which to select alternative therapies.”