The following article is a part of conference coverage from the American College of Gastroenterology 2021 Annual Meeting , held from October 22 to 27, 2021. The team at Gastroenterology Advisor will be reporting on the latest news and research conducted by leading experts in gastroenterology. Check back for more from ACG 2021.


In the United States, Helicobacter pylori (H pylori) has developed significant resistance to clarithromycin, metronidazole, and levofloxacin, according to research presented at the American College of Gastroenterology (ACG) 2021 Annual Meeting, held from October 22 to 27, 2021, in Las Vegas, Nevada and virtually.

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Investigators conducted a systematic review and meta-analysis of studies published between 2011 and 2021 in the MEDLINE and Embase databases. Data from 15 studies covering 4924 infections were extracted and the pooled rates of resistance to several antibiotics used to treat H pylori were calculated.

The pooled resistance prevalence to the antibiotics studied were as follows: 36.3%  (95% CI, 23.4%-51.4%) for metronidazole, 31.9% (95% CI, 15.8%-53.8%) for levofloxacin, 31.4% (95% CI, 22.6%-41.7%) for clarithromycin, 2.7% (95% CI, 1.4%-5.2%) for amoxicillin, 0.4% (95% CI, 0.1%-3.5%) for tetracycline, 9.2% (95% CI, 3.7%-21.2%) for clarithromycin/metronidazole combination, and 3.7% (95% CI, 1.3%-9.9%) for clarithromycin/metronidazole/levofloxacin combination.

Data from 2 studies showed rifabutin resistance was 0% and 0.5%. There was significant heterogeneity (I2 >70%) in all pooled prevalence estimates.

Investigators concluded, “Data remains scarce about the resistance pattern of H. pylori in the US, with significant heterogeneity among the published data.” “These data underline the decline in efficacy of clarithromycin or levofloxacin containing triple regimens in the US and highlight the potential benefits of using regimens including tetracycline, amoxicillin, and/or rifabutin,” they noted.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

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Ho J, Elfanagely Y, Moss S. Helicobacter pylori antibiotic resistance in the United States over the last 10 years: a systematic review and meta-analysis. Presented at: ACG 2021 Annual Meeting; October 22-27, 2021; Las Vegas, NV and virtual. Abstract 0994.