Misuse of antibiotics is highly contributing to antimicrobial resistance (AMR), leaving patients with infections that are difficult and costly to treat, experts have warned.
Health experts say self-medication, buying antibiotics from chemists without prescriptions and failing to complete prescribed doses are among the practices fuelling the growing threat.
Amref Health Africa in Kenya Country Director Dr Meshack Ndirangu said some patients take antibiotics for shorter periods or at lower doses than prescribed.
This, he said give bacteria an opportunity to survive and develop resistance.
“Sometimes the drug works and now it is not working,” said Dr Ndirangu, also a public health leader and health systems innovator.
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In an interview with The Standard, Ndurangu explained that taking an antibiotic for too short a period, or at too low dose may fail to eliminate the bacteria.
He said misuse also occurs when antibiotics are taken when they are not needed.
At the same time, individuals take antibiotics for conditions that do not require antibiotic treatment.
“As a country, there is too much use of antibiotics. Evidence shows there is non-prescription use of antibiotics, with some chemists not asking for prescriptions,” he added.
Ndirangu, further explained that resistance occurs when bacteria adapt in ways that allow them to survive medicines that previously killed, or controlled them.
For instance, a patient may be given an antibiotic for an infection but fail to improve after several days because the bacteria have become resistant.
In such a scenario, a doctor may therefore be forced to prescribe a stronger or different antibiotic.
The consequences, he said, can be severe, with patients requiring second, or third-line medicines, increasing the cost and burden of treatment.
“This is a huge problem because it means when you are sick, you could suffer because you are not able to recover within 72 hours,” said.
According to Ndirangu, antibiotics resistance can result into production of highly resistant infections.
This could include multidrug-resistant tuberculosis (TB), for whose treatment options are already limited.
The scale of the challenge of AMR is evident in Kenya, where a recent survey in Busia found widespread use of antimicrobials without laboratory confirmation.
Ndirangu said a point prevalence survey conducted in four hospitals along the Kenya-Uganda border found that nearly six in every 10 inpatients were receiving antimicrobials.
In the findings, only six percent of eligible prescriptions had a culture and sensitivity test requested before treatment.
This he said, reveals most antibiotics are prescribed without knowing the pathogen being treated.
In surgical wards, prophylactic antibiotics that should have been stopped within 24 hours were extended in nine out of 10 cases, most commonly following C-Section deliveries.
Dr Ndirangu said the findings revealed that hospital with AMR stewardship committee had nearly two and a half times higher compliance with treatment guidelines and 3.5 times lower irrational prescribing than facilities without such committees.
“AMR does not carry a passport. It moves quietly, through everyday prescriptions, through hospitals wards,” Dr Ndirangu said.
The official warned that resistant organisms detected along the border could quickly become a regional concern.
He said the response to AMR must extend beyond hospitals, noting that antimicrobial use in agriculture and communities also contributes to resistance.
Amref Health Africa spearhead AMR action initiative, that help shape African Union AMR Framework.
Through EquAfrica program, the entity has supported 73 laboratories across Kenya, Uganda, Tanzania and Ethiopia in strengthening the quality of ARM testing.
This is through one health initiative.
Director of Veterinary Services, Ministry of Agriculture and Livestock Development, Dr Allan Azegele said the government is set to tackle AMR.
Among interventions in place, he said is investment in laboratories, hospitals and strengthening how antimicrobials are built in human and animal health.
"We continue to strengthen surveillance and financing yo translate good policy into action," said the government official.
He added that implementation research is also being used to identify what works in Kenyan context at cost effective, so that financing is spent on what delivers results.
"We are focusing on intervention and research to understand how interventions can be evaluated and sustained to inform policy," he said.
"We need solutions not only scientific, but affordable reliable and appropriate for our context," he added.
According to Azegele ICARS should generate evidence on what works, and how it works.
"We encourage one health approach, solutions must reflect reality of patients, livestock keepers, farmers, regulators and communities," he said
"To achieve results, interventions must be designed with stakeholders and not for them," said Azegele.
AMR is not only a health problem but a health security threat, requiring coordinated action across human health, animals and agriculture, added the expert.
Amref Health Africa and the International Centre for Antimicrobial Resistance Solutions (ICARS Africa) are among organisations working with governments to strengthen efforts against AMR.
Dr Ndirangu said Kenya has made progress in developing policies to tackle resistance, but the challenge is turning those policies into action.
“As Kenya, we have good policies that should be used for action,” he said.
At the same time, he warned that the problem extends beyond human medicine.
A significant proportion of antimicrobial use occurs in animals, including through animal feeds, creating another pathway through which resistance can emerge and spread to people.
In an interview, he called for stronger guidance for veterinary practitioners and greater community involvement in the responsible use of medicines in livestock.
Farmers, he said, should not routinely turn to antibiotics when animals fall sick without first determining the underlying cause.
"Better animal husbandry, adequate nutrition, deworming, tick control and good hygiene can help prevent infections and reduce unnecessary antimicrobial use," he said.
The same principle of preventing AmR applies to agriculture, where antimicrobials may be used to manage diseases in crops.
On this, he said agricultural extension officers should help farmers use such products appropriately while promoting other methods of maintaining plant health.
Among plant farming is crop rotation and proper soil management.
He said the interconnected nature of the problem makes a One Health approach essential.
“AMR cannot be addressed by doctors or nurses alone. All cadres should work to make sure policies are in place and implemented,” he said.
At the same time, experts said AMR is increasingly threatening health security, food systems and livelihoods.
Experts spoke during the official launch of Intrenational Center for Antimicrobial Resistance Solutions (ICARS) in Nairobi.
During the event, experts warned that drug-resistant infections could undermine modern medicine and become a growing crisis in Kenya, and across the African continent.
Head of the International Centre for Antimicrobial Resistance Solutions (ICARS) Africa, Dr Titha Dzowela, said AMR is a complex One Health challenge affecting humans, animals, agriculture, food systems and the environment.
“AMR is quietly but urgently becoming one of the greatest threats to global health security,” said Dr Dzowela.
Dzowela warned that inappropriate use and disposal of antimicrobials, coupled with limited diagnostic and surveillance capacity, poor sanitation and gaps in regulation and antimicrobial stewardship, are worsening the threat.
Additionally, Dr Dzowela said Africa needed country led solutions tailored to local challenges rather than approaches imposed from outside.
“Solutions to AMR must be led by the countries most affected, designed with them, not for them,” he said.
ICARS was established with support from the Danish Government to work with low- and middle-income countries to develop, test and scale evidence-based solutions to AMR.
The newly established ICARS Africa regional office in Nairobi will work with governments, researchers and communities to strengthen implementation research and generate evidence to guide antimicrobial stewardship across human, animal and environmental sectors.
On his part, the Chairperson of the ICARS Board of Directors, Prof Henrik Wegener, said the organisation's focus was on developing evidence and practical solutions that countries could use to reduce antimicrobial resistance.
Further, Hendrick Larsen, Head of Corporation at the Royal Danish Embassy in Nairobi, said the partnership reflected Denmark's commitment to supporting practical and locally driven solutions to global health challenges.