Inside prescription by assumption fueling drug resistance

 Once-manageable infections are becoming increasingly difficult to treat as medicines lose their effectiveness. [Courtesy]

Drug resistance, driven by the misuse and overuse of antibiotics, is fast becoming one of Kenya’s most pressing health threats, with consequences that extend across Africa.

In hospitals and communities across the country, once-manageable infections are becoming increasingly difficult to treat as medicines lose their effectiveness.

These include Escherichia coli (E. coli, a bacterium that commonly causes diarrhoea and urinary tract infections); Salmonella (which causes typhoid fever and food poisoning); malaria; leishmaniasis (a parasitic disease spread by sandflies); and Candida (a fungal infection often affecting the mouth or genitals).

Others include HIV; hepatitis (viral infections that damage the liver); Haemophilus influenzae (a bacterium that can cause pneumonia and meningitis); and Listeria (a food-borne bacterium particularly dangerous to pregnant women and newborns).

Many health facilities lack the laboratory capacity required to confirm which pathogens patients are carrying and which antibiotics remain effective. As a result, clinicians are often forced to rely on symptoms alone, while patients self-medicate based on past experience.

“Without laboratory testing, treatment becomes guesswork,” said Susan Kiambi, a senior medical technologist.

“You are treating symptoms, not the underlying cause of the illness, and that is how resistance develops.”

As resistance rises, Kenya risks seeing familiar and once-manageable infections become deadly again.

Kiambi noted that misdiagnosis is particularly common in regions where diseases are assumed rather than confirmed. “In some parts of the Mount Kenya region, malaria is not endemic, yet many patients who present with fever are still treated for malaria,” she said.

According to her, the problem lies in overlapping symptoms and limited testing. “Fever, headaches and body aches can be caused by many infections. Without testing, assumptions take over.”

Misdiagnosis

She added that once a drug appears to work, patients often repeat the same treatment the next time they feel unwell.

“They return to the chemist and ask for the same medicine because it helped before, even when the illness may be completely different.”

This pattern of treatment without diagnosis quietly fuels antimicrobial resistance (AMR). Each unnecessary or inappropriate course of antibiotics gives bacteria another opportunity to adapt, survive and spread.

“People come to pharmacies already knowing what they want,” said Nancy Bowen, director of medical laboratory services at the National HIV Reference Laboratory.

“They name the drug, not the illness. Many believe that because it worked previously, it will work again. Without laboratory confirmation, antibiotics are used blindly.”

Kiambi said laboratories are the missing link in breaking this cycle. “Without microbiology testing, we cannot distinguish between bacterial, viral or parasitic infections. Antibiotics are taken for viral illnesses, or the wrong antibiotic is used for resistant bacteria. Each misuse drives resistance further.”

The scale of the crisis is sobering. The 2023 Global Research on Antimicrobial Resistance study estimates that more than 70 per cent of common bacterial infections in Africa now show resistance to at least one antibiotic.

In some regions, over half of bloodstream infections are caused by resistant pathogens. Globally, AMR contributes to around 700,000 deaths each year, a figure projected to rise to 10 million annually by 2050. Africa already carries roughly 22 per cent of this burden.

Estimates suggest that AMR causes more than 200,000 deaths in sub-Saharan Africa every year. Many of these deaths are preventable with robust diagnostic systems.

Yet nearly 90 per cent of medical cases across the continent are treated without confirmatory testing because laboratory services are weak or unavailable.

Only about 10 African countries currently operate functional national AMR surveillance systems that consistently submit quality-assured data to the World Health Organization’s Global Antimicrobial Resistance and Use Surveillance System (GLASS).

Access to essential diagnostics, such as culture and antibiotic susceptibility testing, remains largely confined to major referral hospitals.

Outside urban centres, clinicians often have no reliable way of determining which antibiotics are effective.

Effective prescribing depends on laboratory evidence, yet such systems remain weak or absent.

“The laboratory is the foundation of rational treatment,” said Nqobile Ndlovu, chief executive of the African Society for Laboratory Medicine (ASLM).

“Many facilities still lack basic microbiology capacity. Without diagnostics, resistance spreads silently. Patients die not because medicines do not exist, but because the right medicine is not identified in time.”

Dr Stephen Muleshe, director of public health, described the clinical consequences. “We are seeing infections that no longer respond to standard antibiotics. Clinicians are left guessing, and patients arrive at referral hospitals when it is already too late. Surveillance and laboratory testing are no longer optional. They are essential.”

At the opening of the Nairobi diagnostics convention, the Ministry of Health emphasised that strengthening laboratory systems is central to health security.

“Antimicrobial resistance threatens to reverse decades of progress in healthcare. Diagnostics and surveillance must be prioritised if we are to protect lives and safeguard the effectiveness of existing medicines,” Dr Muleshe said.

The dangers of resistance are no longer theoretical. A recent study highlighted by ScienceAlert shows that typhoid fever, an ancient and once-treatable disease, is rapidly developing resistance to commonly used antibiotics.

The challenges

Across Africa, misuse of antibiotics in both community and hospital settings has enabled resistant strains to spread. Pathogens such as Salmonella and E. coli, responsible for common infections, are increasingly resistant, turning routine illnesses into prolonged and costly medical emergencies.

“AMR is not confined to hospitals,” said Dr Yenew Kebede, acting director for the Centre for Laboratory Diagnostics and Systems at the Africa Centres for Disease Control and Prevention (Africa CDC).

“It is a community problem. Resistant pathogens move between homes, health facilities and the environment. Strengthening diagnostics, enforcing regulation and educating communities must happen simultaneously.” 

The economic burden is equally alarming. A 2017 World Bank report warned that unchecked AMR could cost the global economy up to 100 trillion US dollars by 2050.

For Africa, the estimated annual economic impact stands at 3.4 billion dollars, driven by longer hospital stays, increased healthcare costs and lost productivity.

Funding remains the single greatest challenge. “Most countries still rely heavily on donor support for AMR programmes,” said Patrick Mumbagizi, regional director for Africa at the Fleming Fund. “Domestic financing is limited and, without sustained investment, laboratory networks and surveillance systems cannot be maintained. The progress achieved over the past decade is at risk.”

Laboratory infrastructure across Kenya and much of Africa remains uneven. While centres of excellence exist, many facilities lack equipment, trained personnel and quality management systems. These gaps delay diagnosis and weaken public health responses.

“The laboratory should guide therapy, not follow it,” Kiambi said. “When testing is absent, treatment becomes trial and error.”

Ms Bowen pointed to the human cost of delayed action. “People only realise the danger of resistance when a simple infection no longer responds to treatment. By then, options are limited and outcomes are worse.”

In recent years, Africa has developed policy guidance to confront the threat. Institutions such as Africa CDC, ASLM and global partners have produced key tools, including the Africa AMR Landmark Report and AMR Surveillance Guidelines for the African Region.

These frameworks support governments in strengthening AMR programmes using a One Health approach that links human, animal and environmental health.

The private sector also has a critical role to play. Responsible pharmaceutical practices, antimicrobial stewardship in hospitals and pharmacies, investment in diagnostics, and public–private partnerships are essential to curbing resistance. Regulation and enforcement must match policy ambition.

Global political momentum is also building. The 2022 World Health Assembly Declaration on Diagnostics and the 2024 United Nations Political Declaration on AMR both underscore the urgency of diagnostics, surveillance and coordinated action.