INTRODUCTION:Antimicrobial resistance among Helicobacter pylori strains has been rising globally, leading to declining eradication rates. We performed a systematic review and meta-analysis of the resistance patterns of H. pylori strains in the United States between 2011 and 2021.METHODS:Ovid MEDLINE, Embase, CINAHL, and Cochrane CENTRAL databases were searched for manuscripts and conference abstracts published between 2011 and 2021 reporting H. pylori antibiotic resistance. A mixed-effects model estimated pooled rates of resistance to clarithromycin, amoxicillin, metronidazole, tetracycline, rifabutin, levofloxacin, or a combination of these, with 95% confidence intervals (CIs).RESULTS:A total of 19 studies including 2,660 samples, met inclusion criteria. The pooled rate of resistance to metronidazole was 42.1% (95% CI 27.3%–58.6%), levofloxacin 37.6% (95% CI 26.3%–50.4%), clarithromycin 31.5% (95% CI 23.6%–40.6%), amoxicillin 2.6% (95% CI 1.4%–5.0%), tetracycline 0.87% (95% CI 0.2%–3.8%), rifabutin 0.17% (95% CI 0.00%–10.9%), and dual clarithromycin and metronidazole 11.7% (95% CI 0.1%–94.0%). Considerable data heterogeneity was evident for pooled resistance prevalence rates (I2 > 50%), with the exception of rifabutin resistance.DISCUSSION:Metronidazole, levofloxacin, and clarithromycin resistance rates each exceed 30%; thus, choosing an empiric antibiotic regimen without knowledge of the likely pattern of antibiotic resistance is not appropriate. Resistance to tetracycline, rifabutin, and amoxicillin remains low. Given the scarcity of available data with considerable heterogeneity among studies, continued surveillance, ideally with a more systematic approach to data collection, is an increasingly important goal in H. pylori management.

Substance use disorders commonly onset during adolescence, yet the best available treatments yield only modest and transient effects. Elucidating treatment mediators is essential for improving treatment options. This review summarizes over 20 years of research on mediators of adolescent substance use treatment; k = 17 studies assessing both treatment or treatment ingredient to mediator (a path) and mediator to treatment outcome (b path) paths were included. Mediators were categorized using the Science of Behavior Change target class framework. Overall, mediation tests supported four of eight self-regulation, two of 10 stress resilience and reactivity, six of 19 interpersonal and social process, and two of four treatment engagement and adherence mediators. To enhance the capacity of this work to inform clinical practice, we recommend future research examine theoretically informed mechanisms using temporally sequenced data among other methodological guidelines. Public Health Significance StatementThe current study offers some support for self-regulatory and treatment engagement and adherence mediators of adolescent substance use treatment, however, heterogeneity in the sample of studies precludes any firm conclusions. A concerted effort to examine key processes of evidence-based adolescent substance use treatments can yield enhanced knowledge to guide practice, as well as intervention refinement and implementation within the community.

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