Prevalence Of Antibiotic Resistance Of H.pylori In Asia:a Systematic Review

Objective: The aim of our systematic review was to summarize the prevalence of the antibiotic resistance rate of H.pylori strains from different Asian countries in recent years.Meanwhile,this systematic review also analyses the potential factors that might influence the antibiotic resistance rate of H.Pylori.And finally provides valuable epidemiological data for H.pylori eradication in clinic.Methods: By established the searching strategy,all relevant studies that published from January 2011 to July 2017 were searched in the PubMed?Cochrane library?EMBASE database.And then,we checked the searching results through previous designed restrictive condition and get preliminary data.To avoid selection bias,we also checked the cited studies that including in the preliminary data.After completed the studies selection,two investigators in this study extracted the data and assessed the quality.The following data were collected from the selected studies: first author,year of publication,study location(country),time of sample collection,patient demographic data,histologic diagnoses,prevalence of antibiotic resistance,and method of resistance assessment.Finally,the extracted data were combined and computed to obtain the total resistance rate in Asia and in different countries of Asia.The influence factors of antibiotic resistance rate(including gender,age,endoscopic findings)were compared as well.The odds ratio(OR)and their95% confidence interval(CI)of different variables related to antibiotic resistance were calculated.Differences with p-values less than 0.05 from a2-tailed test were considered statistically significant.All statistical analyses were performed through the STATA(version 14).Results: 63 studies were included.1.The overall primary antibiotic resistance rates of H.pylori strain isolates in Asia were as follows: clarithromycin(21.9%),metronidazole(78.7%),amoxicillin(3.3%),tetracycline(7.4%),levofloxacin(21.3%).2.H.pylori secondary resistance to clarithromycin,metronidazole,amoxicillin,tetracycline and levofloxacin were 64.3%,62.0%,10.3%,10.4% and 15.7%respectively.3.The rate of primary resistance to metronidazole and levofloxacin was higher in women than in men.In regards to the endoscopic findings,a significant difference was observed in the rate of primary resistance to levofloxacin and clarithromycin between patients with non-ulcer disease and those with peptic ulcer disease.The prevalence estimates did not vary significantly between different age groups.4.The primary antibiotic resistance rate of clarithromycin,metronidazole and levofloxacin has demonstrated an increasing trend in recent years.5.Some countries showed a higher resistance to clarithromycin /metronidazole.Otherwise,amoxicillin/metronidazole,amoxicillin/clarithromycin and amoxicillin/levofloxacin have a lower resistance rate.Furthermore,some countries reported higher triple-drug resistance rates for clarithromycin/levofloxacin/metronidazole.Conclusion: This study found that the resistance rates of H.pylori isolates to most common antibiotics are difference in different countries of Asia,but generally higher than US and Europe.In addition to geographical differences,the resistance rates of patients with different age,gender,and endoscopic findings are also different.At the same time,there is a double drug resistance in some areas.