Characterization of clarithromycin-resistant Helicobacter pylori strains in Iran: A systematic review and meta-analysis

Background: The high prevalence of clarithromycin-resistant strains of Helicobacter pylori is a main challenge for the successful treatment of gastrointestinal infections. Point mutations in the 23S rRNA gene are one of the main mechanisms leading to the resistance to clarithromycin in Iran. The purpose of the present review was to evaluate the prevalence of clarithromycin-resistant H. pylori strains in Iran and to identify the major molecular mechanisms of resistance in the resistant isolates. Methods: Using related keywords and computer search in English and Persian databases (up to November 21, 2016), available data about prevalence of clarithromycin-resistant H. pylori strains and molecular mechanisms of resistance in Iran were retrieved. Relevant articles were selected using pre-defined inclusion and exclusion criteria. Results: The results of the meta-analysis showed that the overall prevalence of clarithromycin-resistant H. pylori strains in Iran is 14.7%. The highest and the lowest resistance to clarithromycin were reported from Kashan (33.7%) and Rasht (5.5%), respectively. The most prevalent point mutations in Iran were A2143G (59.1%), A2142G (17.8%), A2142C (8.8%), and A2144G (6.2%), respectively. Conclusion: The prevalence of clarithromycin-resistant H. pylori strains was in an acceptable level in our region. Therefore, clarithromycin can be used for the eradication of H. pylori infection in Iran. However, it seems that investigation about the role of other mechanisms involved in the induction of resistance to clarithromycin is needed. (C) 2017 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.