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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, Dr Constanza Camargo and colleagues from Maryland, USA summarized published literature and calculated region- and country-specific prevalences of antibiotic resistance. Searches of PubMed and regional databases for observational studies evaluating Helicobacter pylori antibiotic resistance yielded a total of 59 independent studies published up to 2013 regarding Helicobacter pylori isolates collected between 1988 and 2011. The team summarized study-specific prevalences of primary resistance to commonly prescribed antibiotics using random-effects models.  | | Prevalence of antimicrobial primary resistance among adults was 53% for metronidazole | | American Journal of Gastroenterology |
Between-study heterogeneity was assessed by meta-regression. As a sensitivity analysis, the research team extended their search to studies of patients with prior Helicobacter pylori-eradication therapy. Summary prevalences of antimicrobial primary resistance among adults varied by antibiotic, including 12% for clarithromycin, 53% for metronidazole, 4% for amoxicillin, 6% for tetracycline, 3% for furazolidone, 15% for fluoroquinolones, and 8% for dual clarithromycin and metronidazole. The team observed that resistance prevalence varied significantly by country, but not by year of sample collection. Analyses including studies of patients with prior therapy yielded similar estimates. The researchers found that pediatric reports were too few to be summarized by meta-analysis. Dr Camargo's team concludes, "Resistance to first-line anti-Helicobacter 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."
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