Antibiotic Resistance of Helicobacter Pylori Infection and Its Eradication Rate in Different Regions of Iran; A Review

Helicobacter pylori infection is one of the most common bacterial infections that is affecting approximately half of the world's population. This bacterial infection causes gastrointestinal diseases, including gastritis and peptic ulcers. It is also the only microbial agent with definite association with gastrointestinal cancers such as adenocarcinoma and gastric mucosal lymphoma. The prevalence of this infection in Iran is reported to be 36% to 90% in different regions. Therefore, eradication of this germ is of great importance and has always been of interest to clinical researchers.

The aim of this study was to evaluate the antibiotic resistance of Helicobacter pylori infection in different regions of Iran based on previous studies. Also, introducing the most effective antibiotics based on antibiotic susceptibility in Iran is the ultimate goal of this study.

Many studies have been done in different regions of Iran to show the antibiotic resistance of Helicobacter pylori, but no comprehensive review of these studies has been done until 2019. It is worth noting that the prevalence of resistance to antimicrobial therapies is increasing. Therefore, we conducted a review of these studies to obtain comprehensive results on the antibiotic susceptibility of Helicobacter pylori. We searched the databases of Google Scholar, Scopus, and PubMed and reviewed the studies in Iran until 2019 with more emphasis on the last five years.

A total of 48 articles were reviewed, the results are summarized in the tables, and the best antibiotics to affect on Helicobacter pylori infection were also identified. It is worth noting that eradication rates in different regions of Iran based on different treatment regimens of three, four, and concomitant drugs in different studies have also been shown in tables, separately.

According to available data, the best first-line eradication regimen in Iran appears to be a 14-day quadruple therapy with amoxicillin, clarithromycin, bismuth, and a proton pump inhibitor (PPI). Cases of treatment failure should also be treated with a combination of amoxicillin and levofloxacin, or amoxicillin and rifabutin in combination with a PPI after evaluation and determination of antibiotic resistance.