Abstract
BACKGROUND AND AIMS: The increasing prevalence of antibiotic-resistant Helicobacter pylori (H. pylori) strains represents a critical impediment to successful eradication therapy in both pediatric and adult populations. This meta-analysis aimed to determine the current global landscape of primary antibiotic resistance in bacterial isolates obtained from children. METHODS: A systematic literature search was conducted across ISI Web of Science, PubMed, Scopus, and Google Scholar, encompassing the period from the inception of each database up to December 2021. Eligible studies reporting primary antibiotic resistance in H. pylori isolates from children worldwide were included. Resistance rates were expressed as percentages with corresponding 95% confidence intervals. Statistical analysis was performed using Comprehensive Meta-Analysis 2.2. RESULTS: One hundred eleven teens were included in this meta-analysis, and 36,021 isolates of this bacterium were evaluated. The resistance rate was reported 25.6%, 30.9%, 2.5%, 2.0%, 12.1%, 6.9%, 1.9%, 0.5%, and 9.1%, for clarithromycin, metronidazole, amoxicillin, tetracycline, levofloxacin, ciprofloxacin, furazolidone, nitrofurantoin, and rifampin respectively. Furthermore, the pooled prevalence of primary multidrug resistant isolates was 4.5%. CONCLUSION: This meta-analysis reveals a significant global burden of primary resistance to clarithromycin and metronidazole in pediatric H. pylori isolates, with evidence of increasing resistance over time. Conversely, resistance rates to amoxicillin, tetracycline, levofloxacin, ciprofloxacin, furazolidone, nitrofurantoin, and rifampin remained low. Consequently, therapeutic regimens incorporating clarithromycin and metronidazole should be carefully considered and potentially avoided in regions exhibiting resistance rates exceeding 20%.