Tetracycline Resistance Pattern Among Lymphatic Filariasis‐Hyperendemic Communities in Southern Ghana: A Mixed‐Method Approach

ABSTRACT Background and Aim Tetracyclines continue to serve as a cost‐effective and essential treatment for common infections, particularly in resource‐limited regions such as lymphatic filariasis (LF)‐hyperendemic communities. The growing use of tetracycline‐based antibiotics by symptomatic filarial lymphedema patients, likely influenced by the demonstrated benefits of anti‐ Wolbachia therapy, especially following doxycycline trials, underlines the necessity for vigilant monitoring of tetracycline resistance patterns. This study evaluated patients' antibiotic knowledge, attitude and practice in LF‐endemic communities, and the resistance profiles of tetracycline‐class antibiotics to assess the clinical impact of resistance on current anti‐ Wolbachia treatments. Methods This cross‐sectional study in Ghana's Ahanta West District enrolled 71 filarial lymphedema patients from four LF‐hyperendemic communities. Structured questionnaires evaluated KAP on antibiotic use and resistance, complemented by microbiological analysis of wound swabs from 28 patients to profile the wound microbiome and assess tetracycline resistance. Results Mean antibiotic knowledge (1.8 ± 1.0), attitude (1.4 ± 1.1), and practice (1.9 ± 1.1) scores were low, yielding a combined KAP score of 5.0 ± 1.9 (31.2% ± 11.9%) with no significant correlation to the educational level of patients. the facilities survey, the primary healthcare facilities in the area stocked at least one tetracycline‐class antibiotic (specifically tetracycline and/or doxycycline). Microbiological testing identified 68 distinct bacterial isolates (20 genera, 36 species; dominated by S. sciuri , S. aureus ). Varied tetracycline resistance observed: doxycycline (35.3%), tetracycline (26.5%), and minocycline (17.6%), with nine (13.2%) isolates resistant to all three. High‐resolution melting analysis detected tet(M) gene in 34.1% (14) of isolates with Tm variation (69.27°C–73.06°C), suggesting variants. Conclusion Multifaceted strategies are essential to curb tetracycline resistance and overuse. These include culturally adapted education to enhance antibiotic stewardship among patients and providers, optimized wound care protocols addressing polymicrobial infections through improved hygiene and tailored regimens, and ongoing resistance surveillance to track trends while promoting therapeutic alternatives.