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
Hauptverfasser: Lopo, Inês, Libânio, Diogo, Pita, Inês, Dinis‐Ribeiro, Mário, Pimentel‐Nunes, Pedro
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container_issue 4
container_start_page e12493
container_title Helicobacter (Cambridge, Mass.)
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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.
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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 &amp; 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 &amp; 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 &amp; Sons Ltd</rights><rights>2018 John Wiley &amp; Sons Ltd.</rights><rights>Copyright © 2018 John Wiley &amp; 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 &amp; 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 &amp; 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 &amp; 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 &amp; 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 &amp; 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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