<p>Search strategies used in the review.</p>

Helicobacter pylori is one of the most widespread pathogens in humans and a strong predictor of gastric cancers. This systematic review and meta-analysis (PROSPERO: CRD420261375391) aimed at determining the extent, clinical impact, and antibiotic resistance profile of H. pylori infections in Cameroon. Six databases were exploited to identify relevant studies published between 2000 and 2026, as per PRISMA guidelines. Pooled proportions were computed using random effects models, while sensitivity analyses were performed to identify confounding factors. A total of 46 studies were included. The pooled proportion of H. pylori infection was 56.7% (95%CI 51.1 – 62.1%), with higher estimates found in i) clinical settings (57.0%), ii) the regions of Centre (62.2%) and Littoral (58.5%), iii) adults (59.7%), and individuals with gastrointestinal disorders (60.1%). The burden of H. pylori was positively correlated with gastric disease severity, with 64.5% of infection cases seen in gastric cancer. Infections have led to adverse clinical effects (e.g., anemia). H. pylori isolates were highly resistant to metronidazole (87.6%, 95%CI 62.4 – 96.8%), while the lowest resistant rates were found for levofloxacin (1.1%, 95%CI 0.4 - 3.2%) and rifampicin (0.6%, 95%CI 0.1 - 2.2%). An unusually high resistance rate to amoxicillin (93.4%; 95% CI 85.9–97.0%) was observed, warranting confirmatory studies. Multidrug-resistant isolates accounted for 77.6%. Several urgent challenges, including the lack of studies in four regions, in other at-risk groups (e.g., obese), limited clinical data, and resistance status vis-à-vis other commonly prescribed ATBs (i.e., amoxicillin), have been identified. This comprehensive study provides baseline data to improve therapeutic management and resistance stewardship in Cameroon.