title: The problem of Helicobacter pylori resistance to antibiotics: a systematic review in Latin America.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
authors.forename: M Constanza
authors.initials: MC
authors.lastname: Camargo
authors.affiliation: Department of Microbiology, Universidad de Concepcion, Concepcion, Chile.
authors.forename: Apolinaria
authors.initials: A
authors.lastname: García
authors.affiliation: Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica, Santiago, Chile.
authors.forename: Arnoldo
authors.initials: A
authors.lastname: Riquelme
authors.affiliation: 1] Department of Gastroenterology, School of Medicine, Universidad Nacional, Bogota, Colombia [2] Clinica Fundadores, Bogotá, Colombia.
authors.forename: William
authors.initials: W
authors.lastname: Otero
authors.affiliation: Secretaría de Salud, México City, México.
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Camargo
authors.affiliation: Department of Microbiology, Universidad de Concepcion, Concepcion, Chile.
authors.forename: Tomas
authors.initials: T
authors.lastname: Hernandez-García
authors.affiliation: Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica, Santiago, Chile.
authors.forename: Roberto
authors.initials: R
authors.lastname: Candia
authors.affiliation: Division of Preparedness and Emerging Infections, Artic Investigations Program, Centers for Disease Control and Prevention, Anchorage, Alaska, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Bruce
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Rabkin
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D024901:Drug Resistance, Multiple, Bacterial; D016481:Helicobacter Infections / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D007843:Latin America; D015233:Models, Statistical
chemical_list: D000900:Anti-Bacterial Agents