The increasing antimicrobial resistance of Helicobacter pylori in Iran: A systematic review and meta‐analysis

Background Antimicrobial resistance of Helicobacter pylori can result in eradication failure. Metadata on the antimicrobial resistance of H pylori in Iran could help to formulate H pylori eradication strategies in Iran. Methods A systematic review was performed after searching in MEDLINE, Scopus, Embase, Web of Science, and the Cochrane Library. A meta‐analysis was performed, and a comparison of the rates between children and adults; time periods (1999‐2010, 2011‐2016, 2017‐2019); and the methods used was carried out. Results A total of 66 studies investigating 5936 H pylori isolates were analyzed. The weighted pooled resistance (WPR) rates were as follows: clarithromycin 21% (95% CI 16‐26), metronidazole 62% (95% 57‐67), clarithromycin in combination with metronidazole 16% (95% CI 10‐23), ciprofloxacin 24% (95% CI 15‐33), levofloxacin 18% (95% CI 9‐30), erythromycin 29% (95% CI 12‐50), furazolidone 13% (95% CI 4‐27), tetracycline 8% (95% CI 5‐13), and amoxicillin 15% (95% CI 9‐22). During the three time periods, there was an increased resistance to amoxicillin, clarithromycin, ciprofloxacin, furazolidone, and tetracycline (P ˂ .05). Furazolidone and a clarithromycin/metronidazole combination had the higher resistance rates in children (P ˂ .05). Conclusion An increasing rate of resistance to amoxicillin, clarithromycin, ciprofloxacin, furazolidone, and tetracycline in Iranian H pylori isolates was identified. In children, the resistance to furazolidone and a combination of clarithromycin and metronidazole is higher compared to adults. As a stable, high resistance to metronidazole was found in children and adults in all Iranian provinces, we suggest that metronidazole should not be included in the Iranian H pylori eradication scheme.