The Problem of Helicobacter pylori Resistance to Antibiotics: A Systematic Review in Latin America

Abstract

OBJECTIVES Latin America has a high prevalence of Helicobacter pylori infection and associated diseases, including gastric cancer. Antibiotic therapy can eradicate the bacterial infection and decrease associated morbidity and mortality. To tailor recommendations for optimal treatments, we summarized published literature and calculated region- and country-specific prevalences of antibiotic resistance. METHODS Searches of PubMed and regional databases for observational studies evaluating H. pylori antibiotic resistance yielded a total of 59 independent studies (56 in adults, 2 in children, and 1 in both groups) published up to October 2013 regarding H. pylori isolates collected between 1988 and 2011. Study-specific prevalences of primary resistance to commonly prescribed antibiotics were summarized using random-effects models. Between-study heterogeneity was assessed by meta-regression. As a sensitivity analysis, we extended our research to studies of patients with prior H. pylori-eradication therapy. RESULTS Summary prevalences of antimicrobial primary resistance among adults varied by antibiotic, including 12% for clarithromycin (n = 35 studies), 53% for metronidazole (n = 34), 4% for amoxicillin (n = 28), 6% for tetracycline (n = 20), 3% for furazolidone (n = 6), 15% for fluoroquinolones (n = 5), and 8% for dual clarithromycin and metronidazole (n = 10). Resistance prevalence varied significantly by country, but not by year of sample collection. Analyses including studies of patients with prior therapy yielded similar estimates. Pediatric reports were too few to be summarized by meta-analysis. CONCLUSIONS Resistance to first-line anti- H. pylori antibiotics is high in Latin American populations. In some countries, the empirical use of clarithromycin without susceptibility testing may not be appropriate. These findings stress the need for appropriate surveillance programs, improved antimicrobial regulations, and increased public awareness.

Susceptibilidad antibiótica de Helicobacter pylori: un estudio de prevalencia en pacientes con dispepsia en Quito-Ecuador

“…En nuestro estudio se encontró que el 43% de cepas presenta una CMI ≥0,125, clasificadas como resistentes, un porcentaje elevado si se toma en cuenta que para América Latina se encuentra entre el 0%-39%; y aún más para el Ecuador, que en años anteriores no se superaba el 4% (17,18). No obstante, similar a lo que ocurre con el uso de la claritromicina, Nishizawa y colaboradores demostraron que, luego de varios intentos fallidos de erradicación utilizando amoxicilina dentro del esquema terapéutico, se incrementó el número de aislados resistentes del 49,5% a 72% (23).…”

“…En nuestro estudio no se obtuvieron datos sobre el consumo previo de antibióticos relacionados o no a terapia de erradicación; sin embargo, se seleccionaron pacientes con dispepsia recurrente y que posiblemente recibieron terapéutica antimicrobiana previa. Una resistencia del 63% al metronidazol se encuentra dentro del rango reportado para América Latina (12,5%-95%) y para Ecuador del 80,9% (17,18).…”

Mutations frequency of RdxA a nitroreductase Helicobacter pylori for activation of metronidazole: a population study in the Department of Cauca

“…Sin embargo, la resistencia de la bacteria al metronidazol es una de las causas del fracaso del tratamiento de dolencias gástricas (7). En los estudios en los que se emplearon métodos fenotípicos (dilución en agar) en Bogotá, Trespalacios, et al, encontraron una prevalencia de resistencia al metronidazol de 81 % (38); en otro estudio en Pereira, la prevalencia fue de 88 % (29).…”

“…En varias revisiones sistemáticas se ha reportado una gran heterogeneidad en las frecuencias de prevalencia de la resistencia primaria al metronidazol en los países latinoamericanos, y cabe resaltar que Colombia presenta la tasa de resistencia más alta, 83 % (7,8).…”

Helicobacter pylori Gastritis: Susceptible to Further Testing?

“…The conclusions of the authors from these aforementioned studies reflect a distinct change in the approach to management of H. pylori infection, which is targeted therapy based on resistance profiles, rather than the disease outcomes. Furthermore, and closer to home, a recent review from Latin America described high rates of resistance of H. pylori to first-line antibiotics; the authors recommended susceptibility testing prior to the use of clarithromycin [11]. Therefore, treatment failure, primarily due to increasing resistance rates, raises the cost of H. pylori infection management and the burden of this infection and associated disease to the patient and their family.…”