Recommendations and Adjuvant Therapies to Mitigate Clarithromycin-Resistant Helicobacter pylori-Associated Infections in Africa

Komla Mawunyo Dossouvi,1 Fábio Parra Sellera,2,3 Ephraim Ehidiamen Ibadin,4 Kossi Wonouvo Gnagnon,5 Amr Elkelish6,7 1Department of Microbiology, Global Health Research Institute, Lomé, Togo; 2Department of Internal Medicine, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil; 3School of Veterinary Medicine, Metropolitan University of Santos, Santos, Brazil; 4Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin, Nigeria; 5Département de Lettres Modernes, Faculté des lettres, langues et arts (FLLA), University of Lomé, Lomé, Togo; 6Department of Botany and Microbiology, Faculty of Science, Suez Canal University, Ismailia, 41522, Egypt; 7Department of Biology, College of Science, Imam Muhammad Ibn Saud Islamic University (IMSIU), Riyadh, 11623, Saudi ArabiaCorrespondence: Komla Mawunyo Dossouvi, Email [email protected]: Helicobacter pylori, (H. pylori) is responsible for approximately 90% of the global burden of non-cardiac gastric cancer. In Africa, first-line therapy combines antimicrobials (eg, amoxicillin and clarithromycin) with proton pump inhibitors (PPIs), whereas second-line therapies (levofloxacin-based triple therapy, sequential non-bismuth quadruple therapy, or bismuth-based quadruple therapy) combine antimicrobials (amoxicillin, clarithromycin, nitroimidazole, levofloxacin, or tetracycline) with PPIs and bismuth compounds. Antimicrobial-resistant H. pylori strains have been widespread worldwide and clarithromycin-resistant H. pylori strains (CRHp) are emerging as a seven-fold risk of treatment failure when using a clarithromycin-based regimen. Efficient prevention, detection, and treatment of CRHp-associated infections have become imperative in Africa and should be in accordance with the reality of the African continent. In this mini-review, we briefly highlighted the problem of the emergence of CRHp isolates in Africa and provided recommendations and adjuvant therapies for the successful prevention, detection and treatment of CRHp-associated infections in Africa. The recommendations included the implementation of prevention measures, standardized antimicrobial susceptibility testing methods, strengthening the surveillance, and promoting antimicrobial stewardship, while phytotherapy and probiotics were discussed as potential adjuvant therapies to conventional antimicrobial treatments. While awaiting the full implementation of these measures, the treatment of H. pylori infections should be based on the guidelines of the AHMSG First Lagos Consensus.Keywords: antimicrobial resistance, Africa, gastric infection, clarithromycin resistance, global priority pathogens