Abstract：
BACKGROUND: Helicobacter pylori antibiotic resistance has undergone vast changes in the last two decades. No systematic review has been done on the prevalence of antibiotic resistant H. pylori in India in the last two decades. We evaluated the pattern of resistance rates across various regions of India.
METHODS: A systematic review of the geographical variations in antibiotic resistance pattern of H. pylori was conducted using PubMed, Google Scholar, Web of Science, Science Direct, etc. for articles published between January 1, 2000 and May 30, 2023. Random effects-model-based Cochran\'s Q test, I2 statistics, and chi-squared tests were used to measure heterogeneity.
RESULTS: The overall resistance was highest against metronidazole (77.65%) followed by amoxicillin (37.78%), levofloxacin (32.8%), clarithromycin (35.64%), furazolidone (12.03%), and tetracycline (11.63%). 14.7% of the H. pylori isolates were multi-drug resistant. Under meta-analysis of each antibiotic, high heterogeneity levels were observed having I2 ranges from 86.53% to 97.70% at p < 0.0001. In sub-group analysis, Metronidazole has a stable rate of resistance as compared to other antibiotics. Other antibiotics have had a downtrend in the last 5 years except for levofloxacin, which has had an uptrend in the resistance rate for the past 5 years. Hence, one should avoid using metronidazole for any kind of first-line treatment.
CONCLUSIONS: Metronidazole resistance is high in most regions of India except Assam and Mumbai while clarithromycin is found to be ineffective in South India, Gujarat, and Kashmir. As compared to other antibiotics, resistance to amoxicillin is generally low except in certain regions (Hyderabad, Chennai, and the Gangetic belt of North India). Tetracycline and Furazolidone have the least resistance rates and should be part of anti- H. pylori regimens. The resurgence of high single and multidrug resistance to the commonly used drugs suggests the need for newer antibiotics and regular resistance surveillance studies.
METHODS: A systematic review of the geographical variations in antibiotic resistance pattern of H. pylori was conducted using PubMed, Google Scholar, Web of Science, Science Direct, etc. for articles published between January 1, 2000 and May 30, 2023. Random effects-model-based Cochran\'s Q test, I2 statistics, and chi-squared tests were used to measure heterogeneity.
RESULTS: The overall resistance was highest against metronidazole (77.65%) followed by amoxicillin (37.78%), levofloxacin (32.8%), clarithromycin (35.64%), furazolidone (12.03%), and tetracycline (11.63%). 14.7% of the H. pylori isolates were multi-drug resistant. Under meta-analysis of each antibiotic, high heterogeneity levels were observed having I2 ranges from 86.53% to 97.70% at p < 0.0001. In sub-group analysis, Metronidazole has a stable rate of resistance as compared to other antibiotics. Other antibiotics have had a downtrend in the last 5 years except for levofloxacin, which has had an uptrend in the resistance rate for the past 5 years. Hence, one should avoid using metronidazole for any kind of first-line treatment.
CONCLUSIONS: Metronidazole resistance is high in most regions of India except Assam and Mumbai while clarithromycin is found to be ineffective in South India, Gujarat, and Kashmir. As compared to other antibiotics, resistance to amoxicillin is generally low except in certain regions (Hyderabad, Chennai, and the Gangetic belt of North India). Tetracycline and Furazolidone have the least resistance rates and should be part of anti- H. pylori regimens. The resurgence of high single and multidrug resistance to the commonly used drugs suggests the need for newer antibiotics and regular resistance surveillance studies.
摘要：
背景：在过去的二十年中，幽门螺杆菌的抗生素耐药性发生了巨大变化。在过去的二十年中，尚未对印度的抗生素耐药性幽门螺杆菌的患病率进行系统评价。我们评估了印度各个地区的耐药率模式。
方法：使用PubMed，谷歌学者，WebofScience,科学直接，等。适用于2000年1月1日至2023年5月30日之间发表的文章。基于随机效应模型的科克伦Q检验，I2统计，卡方检验用于测量异质性。
结果：对甲硝唑的总体耐药性最高（77.65%），其次是阿莫西林（37.78%），左氧氟沙星（32.8%），克拉霉素(35.64%),呋喃唑酮（12.03%），和四环素(11.63%)。14.7%的幽门螺杆菌分离株存在多重耐药。在每种抗生素的荟萃分析下，在p<0.0001时，观察到高异质性水平的I2范围为86.53％至97.70％。在分组分析中，甲硝唑与其他抗生素相比具有稳定的耐药率。除左氧氟沙星外，其他抗生素在过去5年中呈下降趋势，在过去的5年里，阻力率一直呈上升趋势。因此，应避免使用甲硝唑进行任何类型的一线治疗。
结论：除阿萨姆邦和孟买外，印度大多数地区对甲硝唑的耐药性很高，而克拉霉素在印度南部无效，古吉拉特邦,克什米尔。与其他抗生素相比，除某些地区外，对阿莫西林的耐药性普遍较低(海得拉巴，钦奈,和印度北部的恒河带）。四环素和呋喃唑酮的耐药率最低，应该是抗幽门螺杆菌治疗方案的一部分。对常用药物的高单药和多药耐药性的复苏表明需要更新的抗生素和定期的耐药性监测研究。
方法：使用PubMed，谷歌学者，WebofScience,科学直接，等。适用于2000年1月1日至2023年5月30日之间发表的文章。基于随机效应模型的科克伦Q检验，I2统计，卡方检验用于测量异质性。
结果：对甲硝唑的总体耐药性最高（77.65%），其次是阿莫西林（37.78%），左氧氟沙星（32.8%），克拉霉素(35.64%),呋喃唑酮（12.03%），和四环素(11.63%)。14.7%的幽门螺杆菌分离株存在多重耐药。在每种抗生素的荟萃分析下，在p<0.0001时，观察到高异质性水平的I2范围为86.53％至97.70％。在分组分析中，甲硝唑与其他抗生素相比具有稳定的耐药率。除左氧氟沙星外，其他抗生素在过去5年中呈下降趋势，在过去的5年里，阻力率一直呈上升趋势。因此，应避免使用甲硝唑进行任何类型的一线治疗。
结论：除阿萨姆邦和孟买外，印度大多数地区对甲硝唑的耐药性很高，而克拉霉素在印度南部无效，古吉拉特邦,克什米尔。与其他抗生素相比，除某些地区外，对阿莫西林的耐药性普遍较低(海得拉巴，钦奈,和印度北部的恒河带）。四环素和呋喃唑酮的耐药率最低，应该是抗幽门螺杆菌治疗方案的一部分。对常用药物的高单药和多药耐药性的复苏表明需要更新的抗生素和定期的耐药性监测研究。
