Abstract

Background Antimicrobial resistance ofHelicobacter pylorican result in eradication failure. Metadata on the antimicrobial resistance ofH pyloriin Iran could help to formulateH pylorieradication strategies in Iran. Methods A systematic review was performed after searching in MEDLINE, Scopus, Embase, Web of Science, and the Cochrane Library. A meta-analysis was performed, and a comparison of the rates between children and adults; time periods (1999-2010, 2011-2016, 2017-2019); and the methods used was carried out. Results A total of 66 studies investigating 5936H pyloriisolates were analyzed. The weighted pooled resistance (WPR) rates were as follows: clarithromycin 21 (95 CI 16-26), metronidazole 62 (95 57-67), clarithromycin in combination with metronidazole 16 (95 CI 10-23), ciprofloxacin 24 (95 CI 15-33), levofloxacin 18 (95 CI 9-30), erythromycin 29 (95 CI 12-50), furazolidone 13 (95 CI 4-27), tetracycline 8 (95 CI 5-13), and amoxicillin 15 (95 CI 9-22). During the three time periods, there was an increased resistance to amoxicillin, clarithromycin, ciprofloxacin, furazolidone, and tetracycline (P < .05). Furazolidone and a clarithromycin/metronidazole combination had the higher resistance rates in children (P < .05). Conclusion An increasing rate of resistance to amoxicillin, clarithromycin, ciprofloxacin, furazolidone, and tetracycline in IranianH pyloriisolates was identified. In children, the resistance to furazolidone and a combination of clarithromycin and metronidazole is higher compared to adults. As a stable, high resistance to metronidazole was found in children and adults in all Iranian provinces, we suggest that metronidazole should not be included in the IranianH pylorieradication scheme.