Helicobacter pylori (H. pylori) Eradication Rates and Antibiotic Resistance Pattern in Nigeria, West Africa: A Systematic Review

Introduction: Helicobacter pylori (H. Pylori) infection is universal with variable eradication rates and antibiotic resistance that mirrors the type and quantity of antibiotics used in a particular population. Eradication requires a combination of antibiotics with acid suppressive medication. High antibiotic resistance rates have been documented in some prior studies from Africa. Our aim is to evaluate H. pylori eradication rates and antibiotic resistance pattern in Nigeria. Methods: Eligibility criteria included all full articles that investigated H. pylori eradication rate or antibiotic resistance in Nigeria, published in English and conducted on humans. We searched PubMed, EMBASE, Global Index Medicus (WHO), Africa-Wide Information and African Journals Online (AJOL) from inception of database to April 2021. The results were exported to EndNote 20, de-duplicated, and uploaded to Covidence (a systematic review production tool) for blinded screening by the authors. Disputes were adjudicated as a group. Results: 521 references were initially retrieved, 198 duplicates removed, and 323 references screened by title/abstract. 28 studies met inclusion criteria for full text review, of which 17 were included in the final analysis: 12/17, 4/17 and 1/17 assess eradication, resistance, and both respectively. Eradication: Sample size was 391 with M:F ratio of 1:1.2, age range 13-84 years, mean age 44 (SD 12.6). Average eradication rate per protocol analysis was 61.5% for triple therapy, 79.3% for sequential therapy and 90% for bismuth containing quadruple therapy. Average eradication rate for triple therapy per intention to treat (ITT) was 38.0%. No available data on ITT for sequential and quadruple therapy. Resistance: Sample size was 1865 with M: F ratio of 1:3, age range 13-90 years, mean age 38 (SD 11.12). Average resistance rates of H. pylori to the most studied antibiotics were metronidazole (91.0%), tetracycline (60.0%), amoxicillin (64.0%), clarithromycin (42.6%) and Ciprofloxacin (22.3%). H. pylori was 100% resistant to metronidazole in 7 of 12 studies and to tetracycline in 4 of 12 studies. Ciprofloxacin was 100% susceptible in 4 of 7 studies. Conclusion: H. pylori eradication rate in Nigeria is below the global target of 90%. Resistance to key antibiotics used in treating H. pylori infection in Nigeria is alarmingly high, and yet eradication rates remain reasonable (though suboptimal). The disconnect between these two phenomena is worthy of further investigation.Figure 1