•We need to make Medication Therapy Management mandatory for antibiotics before prescribing or selling, for community pharmacies, and private and public hospitals.
Antibiotic resistance is a dangerous thing. Last December I received a patient who had used more than 21 antibiotics and was still suffering from a UTI (urinary tract infection).
This happens when germs like bacteria develop the ability to defeat the drugs designed to kill them.
We have a major problem because not many novel antibiotic molecules are being made; most of those in the pipeline are just derivatives of existing antibiotics.
The most proven cause of antibiotic resistance in Africa and Kenya is overuse. This can happen when a patient is given several antibiotics repeatedly without proper laboratory tests. Overuse may come from the patients or prescribers, the health workers.
There's also underuse. This happens when patients take drugs for a shorter period than is required. For instance, you need 14 days to treat typhoid, but some health workers will only put patients on a seven-day regimen.
The third is misuse. Healthcare workers may prescribe two antibiotics when one can do the work. This means the patient may end up developing resistance to the two of them.
There’s also a lack of empirical treatment. Most treatments with antibiotics are done when you're not sure what you're treating. Health workers will prescribe a wide range of drugs to cover many conditions because they’re not sure exactly what they are treating.
We also have poor microbiology backgrounds by health workers. They should know where the microorganisms they are fighting are located. Is it in the urinary bladder or eyes? You should then give the right drug to target that place.
Important, there’s also a lack of medication therapy reviews, which give a report of how many antibiotics a patient has been exposed to. With this, the clinician can request culture and sensitivity tests.
We need to make medication therapy management mandatory for antibiotics before prescribing or selling, for community pharmacies, and private and public hospitals.
Health workers must also practise proper prescribing practices. They shouldn’t give the strongest antibiotic the first time. You should start with a mild choice and go to the strongest.
So we need proper prescribing policies and we need to implement the essential drugs list, which shows what a patient should be given first.
We can also use artificial intelligence to fight AMR.
Dr Murithi is a medication therapy management specialist and vice president of practice, Pharmaceutical Society of Kenya
(Edited by V.Graham)