Systematic Reviews
Copyright ©The Author(s) 2015.
World J Methodol. Sep 26, 2015; 5(3): 164-174
Published online Sep 26, 2015. doi: 10.5662/wjm.v5.i3.164
Table 1 Mode of action, resistance mechanisms of antimicrobial agents used for treatment of Helicobacter pylori infection
AntibioticMode of actionResistance mechanisms
MetronidazoleElectron reduction processes, leads to the formation of nitro-anion radicals and subsequent DNA damage(1) Poor drug uptake and/or increased drug efflux; (2) enhanced activity of DNA repair enzymes; (3) increased oxygen scavenging abilities; and (4) decreased antibiotic activation arising from changes in metronidazole-reducing enzymes[16]
ClarithromycinThe inhibition of protein synthesis by binding and slowing down the activity of the bacterial ribosomal unit[17]rRNA-point mutations
AmoxicillinThe inhibition cell wall synthesispbp gene mutations, membrane permeability alterations and efflux pumps[17]
TetracyclineReversible inhibition protein synthesisThree contiguous nucleotides mutation in the 16S rRNA gene[17]
FluoroquinolonesInhibiting DNA gyrase, type II topoisomerase, and topoisomerase IV[17]Point mutations in the quinolones resistance determining regions
RifabutinInhibits the b-subunit of H. pylori DNA-dependent RNA polymerase encoded by the rpoB gene[18]Mutation of the rpoB gene[18]
Table 2 Antibiotic resistance rates in different continental areas
Region (n)ClaAmoMetTetLevRifFur
%%%%%%%
Asia (23748)27.4623.6146.577.3825.2812.4523
South America (587)12.886.5652.85021.23NR0
North America (818)30.8230.5019NRNR
Europe (26024)22.110.3531.191.1514.191NR
Africa (831)5.4640.8775.025015NRNR
Total (52008)19.7414.6747.2211.7018.946.7511.5
Table 3 Quantitative data of the articles
CountriesYearIsolatesClaAmoMetTetLevRifFurMethodRef.
(N)(%)(%)(%)(%)(%)(%)(%)
20149533.7E-Test[20]
20138217.19.864.40DDM[21]
20137815.36.455.1DDM[22]
Iran2012150341078.69.35.3E-T,ADM[23]
201211214.328.676.818.728.6DDM[24]
201119745.223.965.537.161.4DDM[25]
20114214.32.440.54.8ADM[26]
2010121520443E-Test[27]
2010132306.873.49E-Test[28]
20147380.8058.912.3E-Test[29]
20131773121.50.195.420.60.1ADM[30]
China20117384.9061.6013.76.8PCR[31]
201037437.20.363.91.250.3E-Test[32]
2009368.333.394.4016.7DDM[33]
201412436.202.1E-Test[34]
Japan201413525.920.7E-Test[35]
2014107331.140.2ADM[36]
201320486.48.271.357ADM[37]
201115355.6PCR[38]
20106136.1014.8ADM[39]
20142128.5936.30ADM[40]
South Korea201316511.52.4550.7024.55ADM[41]
20131506ADM[42]
201218510.82.230.30.05ADM[43]
20141611.236.6E-Test[44]
Malaysia20141026.8032.306.80E-Test[45]
2011900075.5014.4E-Test[46]
20111872.1037.401E-Test[47]
20091872.1E-Test[48]
20144647.854.373.94.3E-Test[49]
Pakistan201217836378912ADM[50]
20109233248E-Test[51]
20149823.53.911.7DDM[52]
201214918.2045.518.2E-Test[53]
Turkey20126121.3042.69.13.3DDM[54]
20093141.93.241.93.2E-Test[55]
20093813.5ADM[56]
Taiwan20146135.3017.6023.5E-Test[57]
200918010.6026.79.4E-Test[58]
Thailand200912029.2PCR[59]
UAE20102619.2E-Test[60]
India20148058.872.583.853.813.813.8DDM[61]
Vietnam201310333069.95.818.4E-Test[62]
South American
20145411.11.9E-Test[63]
Brazil20137719.510.44000ADM[64]
20113980510230ADM[65]
Colombia201220319.820.5ADM[66]
Cuba2010401085E-Test[67]
PCR
Peru20119536.9ADM[68]
DDM
Uruguay2009798.9035.403.8E-Test[69]
North America
Mexico2011905.519E-Test[70]
Canada20094257E-Test[71]
United States201168630242019E-Test[72]
ADM
Senegal20131081085015E-test[73]
DDM
Nigeria20091866695100E-test[74]
Gambia201264068.8ADM[75]
Tunisia201027315.4051.3E-test[76]
South Africa201020097.5ADM[77]
DDM
201416516.729.4E-test[78]
Germany2013529667.1067.124.9E-test[79]
20134367.5032.711.7E-test[80]
Italy201211135.259.322.1E-test[81]
20112539.9PCR[82]
England20092551E-test DDM[83]
201334323.533E-test[84]
Spain20117114.71.445.1014.5E-test[85]
201011835.6E-test[86]
200910154.635.7E-test[87]
Norway20121025.9022.50E-test[88]
Finland201050580417E-test[89]
201358820.134.52.6ADM[90]
Bulgaria201151917.929.54ADM[91]
2009105718.70.521.353.15ADM[92]
Croatia201238211.90.610.1E-test[93]
20142108.1E-test[94]
Poland201316510.932.71.2E-test[95]
2012512216E-test[96]
2011115340445E-test[97]
Portugal2014180500.634.40.633.9E-test[98]
2011111534.7013.90E-test[99]
Belgium201318913.30.826.1[100]
20111067020.3027ADM[101]
Netherlands20144176.1410.1E-test[102]
201374620.50.6819.9E-test[103]
Ireland201385011.70E-test[104]
201021913.231.5E-test[105]
Southern Europe20147434.716.7E-test[106]