Meta-analysisindependent cross-checkabstract checked I-GUT-111 in-depth review
Antibiotic resistance makes some H. pylori treatments fail
Prevalence of Antibiotic Resistance in Helicobacter pylori: A Systematic Review and Meta-analysis in World Health Organization Regions.
Overview
Savoldi A et al.. Gastroenterology 2018 · PMID 29990487 · DOI 10.1053/j.gastro.2018.07.007
In many regions, more than 15% of H. pylori bacteria resist key antibiotics, and resistance makes standard triple therapy fail far more often.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Map H. pylori resistance.
- How was the study done?
Meta-analysis.
- How many people, animals or samples were studied?
66,142 isolates, 65 countries.
- What was actually found?
Resistance >=15% in most regions; clarithromycin resistance raises failure risk.
- How large was the observed effect?
OR 6.97 for failure.
- What do the results mean in everyday life?
Doctors need to choose treatment based on local resistance.
- What are the study's limitations?
Heterogeneous data.
- What does it say about Elawady's specific claim?
Partly supports the criticism of 'triple therapy'; not of treating H. pylori.
- Do the results apply to Germany and Europe?
Europe has its own resistance data.
- What can explicitly not be concluded from this study?
Cannot show that H. pylori does not cause ulcers.
Scientific in-depth review
1. Full reference
- Authors
- Savoldi A et al.
- Journal
- Gastroenterology
- Year
- 2018
- Identifier
- PMID 29990487 DOI 10.1053/j.gastro.2018.07.007
- Verification
- verified – PubMed efetch 2026-10-26 + Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
NIH (NIDDK) and other support; one author's disclosures noted
2. Research question
What is the prevalence of H. pylori antibiotic resistance worldwide and its effect on treatment failure?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of H. pylori antibiotic resistance by WHO region
- Population
H. pylori isolates from 65 countries
- Country
International (incl. Eastern Mediterranean region)
- Period
Published 2018
- Sample size
178 studies; 66,142 isolates
- Inclusion and exclusion criteria
Studies reporting resistance rates
4. Methods and endpoints
- Exposure / intervention
Antibiotic resistance
- Comparator
Susceptible isolates
- Endpoints
Resistance prevalence; treatment failure
- Statistical methods
Random-effects pooling; ORs for failure
5. Actual results
- Results
Primary and secondary resistance to clarithromycin, metronidazole and levofloxacin >=15% in all WHO regions except clarithromycin in the Americas and South-East Asia (10%) and levofloxacin in Europe (11%). Clarithromycin resistance associated with failure of clarithromycin-containing regimens: OR 6.97 (5.23-9.28). I2 >75%.
- Absolute risks
Not reported in abstract
- Authors' conclusion
Resistance has reached alarming levels; local surveillance is needed to choose regimens.
6. Strengths
- Large global dataset
7. Weaknesses
- High heterogeneity
- Uneven country coverage
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Heterogeneity; publication of resistance data uneven.
9. Assessment of the statistical interpretation
OR 6.97 shows resistance strongly predicts failure of clarithromycin triple therapy.
10. Relevance to the specific claim
Acknowledges a correct element: standard clarithromycin triple therapy often fails where resistance is high, so regimen choice matters. It does not support abandoning eradication.
11. Independent contrary findings
Eradication with appropriate regimens prevents ulcer recurrence and gastric cancer (I-GUT-02, I-GUT-03).
12. Transferability to Germany and Europe
Region-specific resistance.
13. Overall methodological judgement
Supports criticism of empiric triple therapy, not of H. pylori causation.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | indirect |
| Reproducibility | replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Current Egyptian resistance rates.