Helicobacter pylori antibiotic resistance in Portugal: Systematic review and meta‐analysis
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 se...
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| Veröffentlicht in: | Helicobacter (Cambridge, Mass.) Mass.), 2018-08, Vol.23 (4), p.e12493-n/a |
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| creator | Lopo, Inês Libânio, Diogo Pita, Inês Dinis‐Ribeiro, Mário Pimentel‐Nunes, Pedro |
| description | 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. |
| doi_str_mv | 10.1111/hel.12493 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2056763049</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2056763049</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3533-587f4bf1af2089fad5d36fe9ebabf8cfa6933ac4e909d853e527c0473333b1113</originalsourceid><addsrcrecordid>eNp1kLFOwzAQhi0EoiUw8AIoEgsMbZ04TmI2VBWKVAkkYEOKHOcMrpyk2AlVNh6BZ-RJcElhQOIW3_Ddf-cPoeMAjwNXkxfQ4yCMGNlBw4CGZERJku66HqdkFJGUDdCBtUuMMSUR20eDkLEgICEboqc5aCXqnIsGjL_qdG2Uz6tG5apulPANWGUbXgnwVeXf1aZpn7m-8O8720DJe-RNwdoNFX4JDf98_-AV152bO0R7kmsLR9vXQ49Xs4fpfLS4vb6ZXi5GglDirk0TGeUy4DLEKZO8oAWJJTDIeS5TIXnMCOEiAoZZkVICNEwEjhLiKnf_Jx4663NXpn5twTZZqawArXkFdWuzENM4iQl2hjx0-gdd1q1x926oOHHCmFvmofOeEqa21oDMVkaV3HRZgLON8swpz76VO_Zkm9jmJRS_5I9jB0x6YK00dP8nZfPZoo_8AuBOjCQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2067083993</pqid></control><display><type>article</type><title>Helicobacter pylori antibiotic resistance in Portugal: Systematic review and meta‐analysis</title><source>Access via Wiley Online Library</source><source>MEDLINE</source><creator>Lopo, Inês ; Libânio, Diogo ; Pita, Inês ; Dinis‐Ribeiro, Mário ; Pimentel‐Nunes, Pedro</creator><creatorcontrib>Lopo, Inês ; Libânio, Diogo ; Pita, Inês ; Dinis‐Ribeiro, Mário ; Pimentel‐Nunes, Pedro</creatorcontrib><description>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.</description><identifier>ISSN: 1083-4389</identifier><identifier>EISSN: 1523-5378</identifier><identifier>DOI: 10.1111/hel.12493</identifier><identifier>PMID: 29911329</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adults ; Amoxicillin ; Animals ; Anti-Bacterial Agents - administration & dosage ; Antibiotic resistance ; Antibiotics ; Bismuth ; Children ; Ciprofloxacin ; Clarithromycin ; Drug resistance ; Drug Resistance, Bacterial ; Helicobacter Infections - drug therapy ; Helicobacter Infections - microbiology ; Helicobacter pylori ; Helicobacter pylori - drug effects ; Helicobacter pylori - genetics ; Helicobacter pylori - isolation & purification ; Helicobacter pylori - physiology ; High resistance ; Humans ; Levofloxacin ; Meta-analysis ; Metronidazole ; Multidrug resistance ; Portugal ; primary resistance ; secondary resistance ; Systematic review ; therapeutic failure ; Therapy</subject><ispartof>Helicobacter (Cambridge, Mass.), 2018-08, Vol.23 (4), p.e12493-n/a</ispartof><rights>2018 John Wiley & Sons Ltd</rights><rights>2018 John Wiley & Sons Ltd.</rights><rights>Copyright © 2018 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3533-587f4bf1af2089fad5d36fe9ebabf8cfa6933ac4e909d853e527c0473333b1113</citedby><cites>FETCH-LOGICAL-c3533-587f4bf1af2089fad5d36fe9ebabf8cfa6933ac4e909d853e527c0473333b1113</cites><orcidid>0000-0002-5093-7788</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fhel.12493$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fhel.12493$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,27931,27932,45581,45582</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29911329$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lopo, Inês</creatorcontrib><creatorcontrib>Libânio, Diogo</creatorcontrib><creatorcontrib>Pita, Inês</creatorcontrib><creatorcontrib>Dinis‐Ribeiro, Mário</creatorcontrib><creatorcontrib>Pimentel‐Nunes, Pedro</creatorcontrib><title>Helicobacter pylori antibiotic resistance in Portugal: Systematic review and meta‐analysis</title><title>Helicobacter (Cambridge, Mass.)</title><addtitle>Helicobacter</addtitle><description>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.</description><subject>Adults</subject><subject>Amoxicillin</subject><subject>Animals</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Antibiotic resistance</subject><subject>Antibiotics</subject><subject>Bismuth</subject><subject>Children</subject><subject>Ciprofloxacin</subject><subject>Clarithromycin</subject><subject>Drug resistance</subject><subject>Drug Resistance, Bacterial</subject><subject>Helicobacter Infections - drug therapy</subject><subject>Helicobacter Infections - microbiology</subject><subject>Helicobacter pylori</subject><subject>Helicobacter pylori - drug effects</subject><subject>Helicobacter pylori - genetics</subject><subject>Helicobacter pylori - isolation & purification</subject><subject>Helicobacter pylori - physiology</subject><subject>High resistance</subject><subject>Humans</subject><subject>Levofloxacin</subject><subject>Meta-analysis</subject><subject>Metronidazole</subject><subject>Multidrug resistance</subject><subject>Portugal</subject><subject>primary resistance</subject><subject>secondary resistance</subject><subject>Systematic review</subject><subject>therapeutic failure</subject><subject>Therapy</subject><issn>1083-4389</issn><issn>1523-5378</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kLFOwzAQhi0EoiUw8AIoEgsMbZ04TmI2VBWKVAkkYEOKHOcMrpyk2AlVNh6BZ-RJcElhQOIW3_Ddf-cPoeMAjwNXkxfQ4yCMGNlBw4CGZERJku66HqdkFJGUDdCBtUuMMSUR20eDkLEgICEboqc5aCXqnIsGjL_qdG2Uz6tG5apulPANWGUbXgnwVeXf1aZpn7m-8O8720DJe-RNwdoNFX4JDf98_-AV152bO0R7kmsLR9vXQ49Xs4fpfLS4vb6ZXi5GglDirk0TGeUy4DLEKZO8oAWJJTDIeS5TIXnMCOEiAoZZkVICNEwEjhLiKnf_Jx4663NXpn5twTZZqawArXkFdWuzENM4iQl2hjx0-gdd1q1x926oOHHCmFvmofOeEqa21oDMVkaV3HRZgLON8swpz76VO_Zkm9jmJRS_5I9jB0x6YK00dP8nZfPZoo_8AuBOjCQ</recordid><startdate>201808</startdate><enddate>201808</enddate><creator>Lopo, Inês</creator><creator>Libânio, Diogo</creator><creator>Pita, Inês</creator><creator>Dinis‐Ribeiro, Mário</creator><creator>Pimentel‐Nunes, Pedro</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5093-7788</orcidid></search><sort><creationdate>201808</creationdate><title>Helicobacter pylori antibiotic resistance in Portugal: Systematic review and meta‐analysis</title><author>Lopo, Inês ; Libânio, Diogo ; Pita, Inês ; Dinis‐Ribeiro, Mário ; Pimentel‐Nunes, Pedro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3533-587f4bf1af2089fad5d36fe9ebabf8cfa6933ac4e909d853e527c0473333b1113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adults</topic><topic>Amoxicillin</topic><topic>Animals</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Antibiotic resistance</topic><topic>Antibiotics</topic><topic>Bismuth</topic><topic>Children</topic><topic>Ciprofloxacin</topic><topic>Clarithromycin</topic><topic>Drug resistance</topic><topic>Drug Resistance, Bacterial</topic><topic>Helicobacter Infections - drug therapy</topic><topic>Helicobacter Infections - microbiology</topic><topic>Helicobacter pylori</topic><topic>Helicobacter pylori - drug effects</topic><topic>Helicobacter pylori - genetics</topic><topic>Helicobacter pylori - isolation & purification</topic><topic>Helicobacter pylori - physiology</topic><topic>High resistance</topic><topic>Humans</topic><topic>Levofloxacin</topic><topic>Meta-analysis</topic><topic>Metronidazole</topic><topic>Multidrug resistance</topic><topic>Portugal</topic><topic>primary resistance</topic><topic>secondary resistance</topic><topic>Systematic review</topic><topic>therapeutic failure</topic><topic>Therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lopo, Inês</creatorcontrib><creatorcontrib>Libânio, Diogo</creatorcontrib><creatorcontrib>Pita, Inês</creatorcontrib><creatorcontrib>Dinis‐Ribeiro, Mário</creatorcontrib><creatorcontrib>Pimentel‐Nunes, Pedro</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Helicobacter (Cambridge, Mass.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lopo, Inês</au><au>Libânio, Diogo</au><au>Pita, Inês</au><au>Dinis‐Ribeiro, Mário</au><au>Pimentel‐Nunes, Pedro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Helicobacter pylori antibiotic resistance in Portugal: Systematic review and meta‐analysis</atitle><jtitle>Helicobacter (Cambridge, Mass.)</jtitle><addtitle>Helicobacter</addtitle><date>2018-08</date><risdate>2018</risdate><volume>23</volume><issue>4</issue><spage>e12493</spage><epage>n/a</epage><pages>e12493-n/a</pages><issn>1083-4389</issn><eissn>1523-5378</eissn><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.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>29911329</pmid><doi>10.1111/hel.12493</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-5093-7788</orcidid></addata></record> |
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| subjects | Adults Amoxicillin Animals Anti-Bacterial Agents - administration & dosage Antibiotic resistance Antibiotics Bismuth Children Ciprofloxacin Clarithromycin Drug resistance Drug Resistance, Bacterial Helicobacter Infections - drug therapy Helicobacter Infections - microbiology Helicobacter pylori Helicobacter pylori - drug effects Helicobacter pylori - genetics Helicobacter pylori - isolation & purification Helicobacter pylori - physiology High resistance Humans Levofloxacin Meta-analysis Metronidazole Multidrug resistance Portugal primary resistance secondary resistance Systematic review therapeutic failure Therapy |
| title | Helicobacter pylori antibiotic resistance in Portugal: Systematic review and meta‐analysis |
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