Doctors raise alarm over H. pylori drug resistance

Its symptoms, including stomach pain, bloating, heartburn and nausea, are increasingly being reported by patients seeking medical care.

Health experts, however, are concerned about possible antibiotic resistance, which can make standard treatment less effective and leave patients experiencing recurring symptoms.

For Jeremiah Isdory, the problem returned twice within six months despite treatment for peptic ulcers.

“I had been experiencing stomach pain for a very long time.. When I went to hospital, I was diagnosed with peptic ulcers and given treatment. After two months, the problem returned,” he said.

Another patient said he underwent treatment for H. pylori with month-long courses of medication more than twice before seeking care at another hospital.  “I went to another hospital where I was given medication for two weeks. That helped and the bacteria was gone,” he said.

The experiences have highlighted the importance of testing, appropriate treatment and follow-up, particularly as doctors report encountering cases in which some medicines no longer work as expected.

Aga Khan Hospital gastroenterologist and hepatologist Dr Masolwa Ng’wanasai said H. pylori requires proper diagnosis and treatment and patients should not start medication before consulting a health professional.

“From our experience as health professionals, we have recently encountered a challenge of drug resistance in this bacterium. Some medicines that have been used for a long time are no longer treating the infection effectively,” he said.

Dr Ng’wanasai said some patients may need alternative medicines or referral to another facility where the required treatment is available. However, he noted that Tanzania does not yet have a national study establishing the extent of H. pylori drug resistance. “So far, we have not seen any study that has been conducted in the country on this challenge,” he said.

The Ministry of Health’s Director of Medical Services, Hamad Nyembea, said H. pylori is treated with antibiotics in accordance with national treatment guidelines. He said patients should undergo testing after completing treatment to determine whether the infection has been cleared.

“As with other diseases, after completing the course of treatment, a patient should be tested to confirm whether they have recovered. If the bacteria is still present, the patient should continue treatment according to the guidelines. Therefore, there are times when a patient may need to take additional medication,” Mr Nyembea said.

According to the treatment guidelines, initial H. pylori therapy includes a proton pump inhibitor (PPI), clarithromycin and amoxicillin. Where resistance develops, patients may need second-line treatment.

Dr Ngwegwe Damas warned against self-medication, particularly buying antibiotics from pharmacies without first undergoing medical assessment.

He said patients could end up taking the wrong medicine or dose, potentially contributing to antimicrobial resistance. “It is very important for people to follow proper hospital treatment instead of treating themselves or going to a pharmacy to obtain medicine without undergoing tests. This will help patients receive the right treatment depending on the severity of their condition,” he said.

Dr Damas also advised patients to undergo follow-up testing at the time recommended by their doctor rather than assuming that the infection has cleared because symptoms have disappeared. “It is very important to test again four weeks after treatment to confirm that the bacteria has been completely eliminated and to prevent the problem from recurring,” he said.

Consultant nephrologist at Benjamin Mkapa Hospital Dr Kessy Shija said inappropriate or prolonged use of some medicines could contribute to antimicrobial resistance.

“Sometimes certain medicines may have already led to resistance. When a patient keeps coming back, resistance can develop,” he said. Dr Shija said recurring symptoms should not automatically lead to patients being given the same medicines without further assessment.

He urged patients to provide doctors with a complete history of previous treatment, including medicines they had already taken and tests they had undergone. “A patient should say that they have previously been treated with these particular medicines or that they have undergone tests several times and received certain medication. This enables the doctor to determine the appropriate way to help them,” he said.

Experts also warned that frequently changing health facilities without providing previous treatment records can make it difficult for doctors to establish a patient’s medical history and determine the appropriate next step.

H. pylori can spread between people through contaminated food or water and poor hand hygiene. Experts say the risk may be higher in areas with inadequate sanitation and limited access to safe water.