title: Worldwide H. pylori antibiotic resistance: a systematic review.
abstract: OBJECTIVE
  Prevalence of H. pylori antibiotic resistance is increasing worldwide, and it is the main factor affecting efficacy of current therapeutic regimens. Our aim was to review recent data on H. pylori resistance towards antibiotics in different countries.
  
  
  METHODS
  A systematic review of studies concerning primary H. pylori antibiotic resistance published through January 2006 to December 2009 was performed. Data were analyzed according to geographic area, age, sex, and gastroduodenal pathology.
  
  
  RESULTS
  The overall H. pylori antibiotic resistance rates were 17.2% (95% CI: 16.5-17.9%) for clarithromycin, 26.7% (95% CI: 25.2-28.1%) for metronidazole, 11.2% (95% CI: 9.6-12.7%) for amoxycillin, 16.2% (95% CI: 14.4-18%) for levofloxacin, 5.9% (95% CI: 4.7-7.1%) for tetracycline, 1.4% (95% CI: 0.81-9%) for rifabutin and 9.6% (95% CI: 8.5-10.7%) for multiple antibiotics. Prevalence rate of clarithromycin, metronidazole, and levofloxacin resistance significantly increased from Europe to Asia, America and Africa. Tetracycline resistance is low (<3%) in all countries, but Africa (43.9%). Prevalence of clarithromycin resistance was higher in non-ulcer dyspepsia patients, whilst metronidazole resistance was higher in peptic ulcer patients. Both resistances were significantly higher in female than in male patients. Data regarding amoxicillin resistance are highly conflicting.
  
  
  CONCLUSIONS
  The worldwide H. pylori antibiotic resistance towards different antibiotics has increased. Such a phenomenon may affect therapeutic management in different countries.
authors.affiliation: Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia, Italy. vdefrancesco@ospedaleriunitifoggia.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Francesco
authors.forename: Floriana
authors.initials: F
authors.lastname: Giorgio
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Manes
authors.forename: Lucy
authors.initials: L
authors.lastname: Vannella
authors.forename: Carmine
authors.initials: C
authors.lastname: Panella
authors.forename: Enzo
authors.initials: E
authors.lastname: Ierardi
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
mesh_terms: D000349:Africa / Q000453:epidemiology; D000569:Americas / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001208:Asia / Q000453:epidemiology; D016009:Chi-Square Distribution; D024881:Drug Resistance, Bacterial; D005060:Europe / Q000453:epidemiology; D005260:Female; D014943:Global Health; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000472:pathogenicity; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents