Current global perspectives on the pharmacotherapy of Helicobacter pylori infection: therapeutic implications for sub-saharan Africa

Helicobacter pylori is associated with many clinical conditions including gastric and extra-gastric pathologies. Prevalence is high in most Sub- Saharan African countries where data is available. Its association with diseases is not fully established in the region. Due to emergence of antibiotic resistance, the conventional triple and quadruple therapies using proton pump inhibitors and antimicrobial agents are now obsolete. Many Western countries have revised their therapeutic guidelines with a common recommendation to determine prior patient exposure to antibiotics, determine local drug resistance patterns and eradication rates, use higher doses of proton pump inhibitors, and include bismuth sub-citrate if clarithromycin resistance is suspected. Sub-Saharan African countries lack data on these making it difficult to apply these recommendations. The countries in Sub-Saharan Africa need to recognize the growing clinical importance of H. pylori and initiate programs to determine its local epidemiology, drug resistance, and its association with diseases in the region. Collaborative effort is required to achieve these goals and establishment of regional reference laboratories for monitoring drug resistance may be helpful. Keywords: Antibiotic resistance, global perspectives, H. pylori , prevalence, Sub-Saharan Africa, therapeutic guidelines