Helicobacter pylori Antimicrobial Resistance.pptx

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1. Background H.pylori gram negative, spiral shaped microaerophilic bacteria Discovered by Barry Marshall & Robin Warren (1982) 1 st Cultured in 1984 1992 associated with Gastric Cancer and Peptic Ulcer Disease Globally distributed with >50% infected Transmitted vertically and horizontally in close proximity Usually acquired early in life with long life infection and Complications A class 1 Oncogene (WHO 1994) and one of the 20 priority pathogen for new antibiotic requirement due to high drug resistance(WHO 2017) Highly genetically diverse and versatile genome R X T3T(proton pump inhibitors (PPI), clarithromycin, and amoxicillin or metronidazole) Q4T (PPI, bismuth, tetracycline, & metronidazole) – Increased antibiotic Resistance

2. Mondley et al., 2012

3. Distribution of resistance pattern of H.pylori Distribution of resistance pattern N Susceptible to all ABs 2 Resistance   Single Metronidazole 15 Amoxycillin 5 Levofloxacin 1 Clarithromycin 1 Double Amoxycillin+ Metronidazole 26 Amoxycillin+ Clarithromycin 1 Clarithromycin + Metronidazole 5 Metronidazole + Levofloxacin 5 Triple Amoxycillin+ Clarithromycin + Metronidazole 25 Amoxycillin+ Metronidazole + Levofloxacin 6 Clarithromycin + , Metronidazole + Levofloxacin 3 Quadruple Amoxycillin+ Clarithromycin + Metronidazole + Levofloxacin 8

4. AMX resistance mutations detected in each H. pylori isolate

5. LEVO resistance mutations detected in each H. pylori isolate  

6. CLA resistance mutations detected in each H. pylori isolate

7. Key points to note • Antibiotic resistance in Helicobacter pylori is a global threat to human health . • Attributes driving this resistance include mainly mutations encoded chromosomally but also physiological changes such as impaired regulation of drug uptake and/or efflux, and biofilm and coccoid formation . • H. pylori frequently displays three different profiles of resistance including single drug resistance, multidrug resistance and heteroresistance . • In individual patients, mechanisms of resistance deployed by H. pylori cause treatment failures, diagnostic difficulties and ambiguity in clinical interpretation of therapeutic outcomes. • At the population scale, increasing antibiotic resistance has globally led to a substantial decrease in H. pylori treatment efficacy and probably an increased risk of complications such as peptic ulcers and gastric cancer . To fight this resistance, efforts needed include development of efficient vaccines, setting new treatment strategies, improving diagnostic tools for optimizing clinical decisions, and a better understanding of driving mechanisms. 

8. Conclusion H. pylori infection and stomach cancer remain major and largely poorly managed public health problems in Kenya and Africa at Large There is an urgent need to develop H. pylori precision medicine and antimicrobial stewardship across the continent A paradigm shift is required to abandon current approaches and embrace antimicrobial stewardship These will achieve high cure rates; develop, propagate, and update best practice guidelines Timely updates to clinicians regarding the current status of resistance, antimicrobial effectiveness . Therefore, we need to work hard to develop innovations that could possibly provide best stomach health solutions for our countries .