H. pylori eradication varies widely across Africa; antibiotic susceptibility review needed
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Key takeaways:
- The pooled eradication rate of H. pylori in Africa was 79%.
- Eradication rate varied by duration of therapy, country and test used to detect H. pylori.
The eradication rate of Helicobacter pylori in Africa varied widely by country, duration of therapy and type of diagnostic test used, underscoring the need for optimized treatment regimens, according to a systemic review and meta-analysis.
“H. pylori eradication rate differs in different settings based on the type of regimen employed, duration of therapy and local antibacterial susceptibility pattern,” Sintayehu Fekadu, of the College of Medicine and Heath Sciences at Hawassa University in Ethiopia, and colleagues wrote in BMC Gastroenterology. “According to a recent systematic review and meta-analysis, first-line treatment had a 98% global H. pylori eradication rate, with a subcontinental success rate of 98% in Asia, 94% in Africa, 94% in Europe, 93% in South America and 84% in North America.”
They continued: “No systematic review or meta-analysis has been conducted on the eradication rate of H. pylori infection in Africa.”
Fekadu and colleagues searched PubMed, Google Scholar, Hinari, Scopus and the Directory of Open Access Journals and identified 22 studies (14 randomized controlled trials, eight observational) from nine African countries, with a total population of 2,163 individuals who tested positive for H. pylori.
According to meta-analysis, the pooled eradication rate was 79% (95% CI, 75-82), with higher rates reported from observational studies (85%; 95% CI, 79-90) compared with randomized controlled trials (77%; 95% CI, 73-82).
Duration of therapy also influenced eradication rates, with higher rates reported for 10-day regimens (88%; 95% CI, 84-92) compared with 7-day regimens (66%; 95% CI, 55-77). In addition, researchers reported variable eradication rates by country, with the highest in Ethiopia (90%; 95% CI, 87-93) and the lowest in Ivory Coast (22.3%; 95% CI, 15-29).
When considering the type of test used to detect H. pylori, a rapid urease test with histology (88%; 95% CI, 77-96) had the highest eradication rate and histology alone (22.3%; 95% CI, 15-29) had the lowest.
“This study demonstrates the need to reassess antibiotic susceptibility in each country and optimize current H. pylori treatment regimens,” Fekadu and colleagues concluded. “Antibiotic susceptibility of H. pylori should be investigated in each nation of Africa.”
They continued, “Although gastrointestinal disorders and associated H. pylori infections are common problems in Africa, less attention is given to translate the efficiency of eradication and improve the eradication regimen. Future [randomized controlled trial] studies with standardized regimens are required.”
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