This updated systematic review and meta-analysis followed two objectives: (1) to determine Helicobacter pylori antibiotic resistance in Iran during 2010–2020 and (2) to assess the trend of resistance from 1997 to 2020. A systematic search in multiple databases, including ISI Web of Knowledge, PubMed, Scopus, Google Scholar, and the Scientific Information Database (SID), was performed using MeSH-extracted keywords. Meta-analysis was done on extracted data from a total of 27 included citations published between 2010 and January 20, 2020. The overall mean prevalence of H. pylori resistance was 64.9% for metronidazole, 25.3% for clarithromycin, 20.7% for amoxicillin, 16.1% for tetracycline, 21.9% for levofloxacin, 22.8% for rifampicin, 27.2% for furazolidone, 32.3% for ciprofloxacin, and 38.7% for erythromycin. In addition, the prevalence of multidrug-resistant strains of H. pylori was 26.5% in Iran. The pooled prevalence of point mutations A2143G, A2142G, and A2142C associated with clarithromycin resistance were 46.6%, 37.2%, and 5.5%, respectively; mutations in frxA and rdxA genes associated with metronidazole resistance were 46.4% and 19.7%, respectively; gyrA and gyrB genes mutations among fluoroquinolone-resistant strains were 55.3% and 48.2%, respectively; and resistance associated with integrons was 47%. According to the present findings, resistance of H. pylori to antibiotics used for eradication therapy has reached an alarming level in Iran. Furthermore, the trend of H. pylori resistance has increased between 1997 and 2020. Hence, continuous surveillance on resistance patterns, logical prescription and appropriate consumption of antibiotics, and selecting effective therapeutic regimens in accordance with local resistance patterns are required to prevent further spread of resistance and ensuing treatment failures.

中文翻译：

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伊朗对幽门螺杆菌抗生素耐药性的最新系统评价和荟萃分析（2010-2020年）。

这项更新的系统评价和荟萃分析遵循两个目标：（1）确定2010–2020年伊朗的幽门螺杆菌抗生素耐药性；（2）评估1997年至2020年的耐药趋势。在多个数据库中进行系统搜索，包括使用MeSH提取的关键字执行了ISI Web of Knowledge，PubMed，Scopus，Google Scholar和科学信息数据库（SID）。对从2010年至2020年1月20日发布的总共27篇引文中的提取数据进行荟萃分析。幽门螺杆菌的总体平均患病率甲硝唑的耐药率为64.9％，克拉霉素为25.3％，阿莫西林为20.7％，四环素为16.1％，左氧氟沙星为21.9％，利福平为22.8％，呋喃唑酮为27.2％，环丙沙星为32.3％，红霉素为38.7％。此外，在伊朗，幽门螺杆菌的多药耐药菌株患病率为26.5％。与克拉霉素耐药有关的点突变A2143G，A2142G和A2142C的合并患病率分别为46.6％，37.2％和5.5％。与甲硝唑耐药相关的frxA和rdxA基因突变分别为46.4％和19.7％；gyrA和gyrB氟喹诺酮耐药菌株中的基因突变分别为55.3％和48.2％。与整合素相关的抵抗力为47％。根据目前的发现，在伊朗，幽门螺杆菌对用于根除疗法的抗生素的耐药性已达到令人震惊的水平。此外，幽门螺杆菌的耐药性趋势在1997年至2020年之间有所增加。因此，需要持续监测耐药性模式，合理处方和合理使用抗生素，并根据局部耐药性模式选择有效的治疗方案，以防止幽门螺杆菌进一步传播。抵抗力和随之而来的治疗失败。