Antimicrobial Resistance Pattern of Moraxella catarrhalis and Haemophilus influenza in Iran; a Systematic Review

Aims: Haemophilus influenzae and Moraxella catarrhalis are common pathogens in respiratory tract infections, causing some diseases like community-acquired pneumonia, acute sinusitis, and otitis media. Antimicrobial resistance in these pathogens occurs over the years. This systematic review aimed to investigate the antibiotic resistance pattern of these pathogens in Iran in the last ۵ years. Materials & Methods: All original articles related to the antimicrobial resistance of H. influenza and M. catarrhalis in Iran since ۲۰۱۸ were searched in English and Persian databases. The articles were screened primarily and secondary. After screening the articles (extracted blindly), conflicts were resolved, and the final data were reviewed. Findings: This study included nine articles after primary and secondary screening steps, comprising ۱۱۱ H. influenzae and ۷۸ M. catarrhalis isolates. The lowest resistance of H. influenzae isolates was against levofloxacin (۰.۰%), cefotaxim (۱۱.۱%), and ceftriaxone (۱۱.۱%), while the highest resistance of these isolates was against tetracycline, co-trimoxazole, and ampicillin. M. catarrhalis isolates showed the highest resistance to penicillin (۱۰۰%), cefazolin (۸۷.۵%), cefuroxime (۸۴.۴%), ampicillin (۸۴.۴%), and amoxicillin (۸۱.۲%). Co-trimoxazole resistance rates of M. catarrhalis isolates from adenoid tissue and pharynx were different. Resistance to fluoroquinolones was ۰.۰%; macrolides were the most effective antibiotics.  Conclusion: Fluoroquinolones and macrolides are the most effective antibiotics for M. catarrhalis, while fluoroquinolones and cefotaxime or ceftriaxone work best for H. influenzae. It is recommended to use fluoroquinolones and macrolides for managing outpatients and fluoroquinolones, macrolides, or ceftriaxone for managing inpatients. Prescription of β-lactams and/or co-trimoxazole is ineffective.

Keywords:

Moraxella Catarrhalis , Haemophilus Influenza , Respiratory Tract Infection , Antimicrobial Resistance