Why overusing antibiotics is putting Kenyan lives at risk

Pills in a trash can. [Courtesy/GettyImages] Antibiotic resistance in Kenya is a serious and growing threat that is driving high mortality, yet it still doesn't get the attention it deserves. Antibiotic resistance (often referred to as antimicrobial resistance or AMR) occurs when bacteria change their characteristics or evolve and can no longer be killed or inhibited by antibiotics. The main driver of this resistance is antibiotic use-misuse or overuse. Antibiotic use in Kenya is alarmingly high, both in communities and hospitals. This is fuelling a silent pandemic of antimicrobial resistance that is threatening the lives and livelihoods of our population. In Kenyan hospitals, antibiotic use is common. Our surveys show that up to 50 per cent of patients admitted to hospitals are started on an antibiotic. Fear of symptoms that may worsen, concerns over the cost of healthcare, or the inconvenience of going to hospitals, pushes many people to buy antibiotics over the counter without seeing a healthcare worker. However, it is important to note that antibiotics only treat infections caused by bacteria and do not treat viruses. Viruses cause most of the common infections such as the common cold, sore throats, mild cough, and most episodes of diarrhoea. Antibiotics do not treat these viral infections. Overuse and misuse of antibiotics lead to the development of resistance in bacteria, which in turn do not respond to the antibiotics. This means that infections caused by bacteria become increasingly difficult, if not impossible, to treat. Common bacterial infections include pneumonia, urinary tract infections, skin infections, blood or abdominal infections. Using antibiotics, which bacteria have become resistant, to treat these infections leads to death, complications, unnecessarily long hospital stays, and increased cost of care. As infectious disease specialists leading the treatment of antibiotic-resistant infections, we often get to a point where there are no options available locally to treat a patient. The truth is that whereas bacteria and bacterial infections are many, antibiotics are not, and the few newer antibiotics that can treat resistant bacteria are expensive and not readily available. Data from many hospital laboratories in Kenya show alarmingly high antibiotic resistance levels. For example, Escherichia coli, the most common bacteria causing urinary and blood infections shows resistance of up to 70 per cent to the commonly used antibiotics. Staphylococcus aureus, the bacteria that causes most infections of the skin structures shows resistance rates of up to 50 per cent to the most commonly and readily available antibiotics. We have found in our work that infections in the blood caused by resistant bacteria are associated with a high risk of death. Our research in Kenyan hospitals is showing that up to six in 10 people with resistant bacteria in blood will die unless we can urgently access some of the recently developed antibiotics. Kenya has made steps in the right direction. With support from the Fleming Fund Country Grant to Kenya, the University of Nairobi (Department of Clinical Medicine and Therapeutics and Center for Epidemiological Modelling and Analysis in collaboration with the National Antimicrobial Stewardship Interagency Committee, have strengthened surveillance of resistant bacteria and antibiotic stewardship across 12 health facilities. We have renovated labs, procured equipment and laboratory supplies, trained microbiologists, and improved data systems-laying the groundwork for understanding the status of antibiotic resistance in the country. These efforts are helping Kenya detect resistant infections earlier and support doctors to prescribe antibiotics more responsibly. But these efforts must be scaled up and sustained. Much of the work relies on external funding. Without local investment, gains could easily stall-and much of the country remains uncovered. Dr Ombajo is an infectious disease specialist and co-director of the Center for Epidemiological Modelling and Analysis at University of Nairobi. Dr Koile is a physician and antimicrobial steward at the Jaramogi Oginga Odinga Teaching and Referral Hospital

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