You need to ask for a urine culture, which will identify the specific bacteria causing your infection and the exact antibiotics that can kill it.
This is the advice from researchers at the Kenya Medical Research Institute, who have reported a disturbing rise in drug-resistant urinary tract infections in Kenya.
Such untreatable UTIs can lead to permanent kidney damage and other life-threatening complications.
The researchers tested urine samples from 1,027 people with UTIs against the commonly used drugs and found many of these medications are becoming useless.
“The present study shows a high prevalence of uropathogens (organisms that infect the urinary tract) with high resistance toward common UTI antibiotics, such as Trimethoprim (64 per cent), Sulfamethoxazole (57 per cent), and Nalidixic Acid (57 per cent),” the researchers said in a new report that has not yet been published.
“Anecdotal data shows that these are the commonly prescribed antibiotics at most outpatient health facilities and are easily available over the counter at chemists and pharmacies,” they added.
Most troubling is the high resistance to Trimethoprim-Sulfamethoxazole, commonly sold as Septrin, the current drug of choice for treating acute uncomplicated cystitis in women.
The patients were recruited from selected hospitals in Nairobi, Nanyuki, and Makueni areas, including Kenyatta National Hospital, Mbagathi County Hospital, Kiambu County Hospital, Mary Mother Mission Mukuru healthcare, Ruiru Family Clinic, Kemri Centre for Microbiology Research Lab, Nanyuki Teaching and Referral Hospital, and Makueni Level 5 Hospital.
Majority of the sick were women (59.3 per cent) compared to men (31.3 per cent). UTI was highest in the age-group 25-30 years at 16.2 per cent and the lowest (1.2 per cent) in children under five years.
Susan Kiiru, a Kemri research scientist who took part in the study, told the Star when bacteria are resistant to antibiotics, it means they are not killed or their growth is not limited by these drugs.
“It is a silent pandemic,” she said, noting that this is a global problem.
In 2019 alone, 1.27 million deaths were recorded from bacterial antibiotic resistance globally. The statistic is higher than the deaths caused by HIV and Malaria.
“It is also worth noting that we are having limited treatment options considering there is resistance to even the last resort or the reserve drugs,” she said.
Most UTIs are usually simple and easily manageable with readily available antibiotics.
Kiiru advised healthcare providers prescribing the antibiotics to use updated guidelines for empirical antibiotic therapy and to carry out urine culture and antimicrobial susceptibility testing.
“For those selling over-the-counter antibiotics, they should always sell full doses and not half doses and they should always ask for a prescription,” she said.
“They should also know the buyers' information like what they intend to treat with the antibiotics they are buying. They should also have updated guidelines for empirical antibiotics guidelines as they dispense.”
The Kemri study is available on the pre-print platform Medrxiv under the title, “Bacterial Etiology of Urinary Tract Infections In Kenyan Health Facilities And resistance towards commonly used antibiotics.”
Other authors are John Maina, Japhet Katana, John Mwaniki, and John Kiiru, all from Kemri.
The study found that Augmentin and Cefepime drugs are the better choices of treatment possibly because these drugs are not the first choice of treatment.
The authors further noted that the proportion of Multidrug-resistant (MDR) pathogens was 66 per cent, with the most common MDR observed being a combination of Nalidixic Acid, Sulfamethoxazole, and Trimethoprim.
The resistance towards the mainstay treatments of UTI, betalactams, Quinolones, Fluoroquinolones, and Aminoglycosides, commonly abbreviated as BFQA, was high in KNH, ranging from 31 per cent to 43 per cent and was lowest at Ruiru Family Clinic ranging from zero to 13 per cent.
The variation in resistance across the counties could be due to self-medication practices where the community members buy the drugs that are available in the chemists around them.
“Self-medicating individuals also predominantly use the same affordable antibiotics. Different areas have a different supply of antibiotics hence the variation in resistance,” the authors said.
This week, the World Health Organization declared antimicrobial resistance as one of the top 10 global health threats facing humanity.
Antimicrobials is the general term for medicines used to prevent or treat infections in people and they include antibiotics, antivirals, antifungals and antiparasitics.
Misuse and overuse of antimicrobials are the main drivers in the development of drug-resistant pathogens.
