Antibiotic resistance in Kenya, the pandemic no one is talking about

Data from many hospital laboratories in Kenya show alarmingly high antibiotic resistance levels.

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, the use of antibiotics is common. Our surveys show that up to 50% 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, push 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, and blood or abdominal infections. Using antibiotics to 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 bacterium causing urinary and blood infections, shows resistance of up to 70%  to the commonly used antibiotics.  Staphylococcus aureus, the bacteria that causes most infections of the skin structure,s shows resistance rates of up to 50% 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 6 in 10 people with resistant bacteria in the 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 Centre for Epidemiological Modelling and Analysis (CEMA) in collaboration with the National Antimicrobial Stewardship Interagency Committee, has strengthened surveillance of resistant bacteria and antibiotic stewardship across 12 health facilities in the country.

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.

Some might argue that AMR is too technical, or too far removed from daily struggles like poverty, hunger, malnutrition or climate change. But ignoring AMR makes every one of those challenges harder to solve.

We all have a role to play in forestalling this pandemic of antibiotic resistance. We must all refrain from buying antibiotics over the counter without a prescription provided by a health care worker, we must observe personal hygiene that includes hand washing in order to reduce the spread of infections. The government should enforce restrictions on the over-the-counter sale of antibiotics and ensure that laboratories are well-equipped to help health care workers identify the correct bacteria causing infections.

Hospitals and healthcare workers must put in place measures to ensure the appropriate use of antibiotics, including prescribing antibiotics only for bacterial infections, ensuring the appropriate use of laboratory data, stopping antibiotics when no longer needed, and observing infection prevention and control measures to prevent the spread of drug-resistant bacteria in hospitals.

As we commemorate World Antibiotic Awareness Week from the 17th to the 21st of November, we must all act now to protect our present and secure our future.

Dr. Loice Ombajo is an Infectious Disease specialist and Co-director of the Center for Epidemiological Modelling and Analysis at the University of Nairobi. 

Dr. Eve Koile is a physician and antimicrobial steward at the Jaramogi Oginga Odinga Teaching and Referral Hospital.