Kenyans are slowly killing themselves by taking half doses of drug prescriptions, hence contributing to the increase in antimicrobial resistance, a study has shown.
The findings by the Kenya Medical Research Institute (Kemri) also indicated that most community drug sellers were advising customers to take just a fraction of the dose, and get the other bits later. Often, the other bits are ignored.
They were presented during the 13th Kemri Annual Scientific and Health conference. Titled Over-the-counter antimicrobial sale in Kenya: A mystery client survey, the report revealed that most of them are not asking for a prescription.
The cross-sectional study designed between 2020 and February 2022 surveyed 462 community drug sellers—Nairobi (313), Makueni (116), and central Kenya (33)—using urinary tract infections as select disease. Of the number surveyed, 129 (24 per cent) sold a half dose, with the majority (73 per cent) advising the customer to purchase the whole medication later.
From 462 chemists, 404 (87 per cent) drug sellers did not ask for a prescription. Despite 58 drug sellers asking for a prescription, only seven (12 per cent) refused to sell antibiotics without a prescription. In addition, only 228 (49 per cent) engaged the buyer, where 181 (39 per cent) asked about the disease history, 25 (five per cent) asked whether a female client was pregnant, and 127 (28 per cent) asked about medication history.
Furthermore, only 43 (nine per cent) recommended that the patient see a doctor, while 10 (two per cent) said there was no need for medication. “Irrational usage and overuse of antibiotics are among the key contributors to the increasing antimicrobial resistance globally. The contemporary argument for self-medication in poor resource settings, especially in low- and middle-income countries, has been poverty and limited rapid diagnostic points of healthcare,” it says.
In Kenya, out-of-hospital antimicrobial dispensing supersedes hospital-based. The study found that out of 10 community drug sellers, eight (85 per cent) lacked awareness of antimicrobial resistance.
A wide variety of antibacterial and antifungal medications were sold over the counter, including amoxil (19 per cent), fluconazole (16 per cent), ciprofloxacin (13 per cent), azithromycin, doxycycline, and nitrofurantoin at nine per cent each respectively, with cefixime, levofloxacin, and metronidazole at four per cent. The study, aimed at assessing the antimicrobial sale practices of community drug sellers in Kenya, concluded that over-the-counter sales continue to derail antimicrobial stewardship.
“Notably, the sale of vital antimicrobials, some of which are on the World Health Organisation and the national watch list, risk stretching the already elevated resistances, narrowing treatment options readily available,” says Dr John Ndemi, a Kemri researcher.
He noted a dire need to strengthen enforcement and adherence to prescription-only sales to alleviate the risk of antimicrobial resistance emergence.
Despite regulation on prescription-only sales, weak enforcement and ignorance by key stakeholders risks perpetuating none-adherence, leading to antimicrobial misuse and over-use.
Dr Fred Siyoi, the chief executive officer of the Pharmacy and Poisons Board, said antimicrobial resistance is one of the biggest threats to global public health.
The annual deaths from drug-resistant infections are projected to increase from the current 700,000 to 10 million globally by 2050 if nothing is done. Researchers estimate that bacterial antimicrobial resistance caused 1.2 million deaths in 2019.
“The major concern is the emergence and spread of multi-drug-resistant bacteria, where it seems we are running out of treatment options. In addition, greater attention should be paid to emerging resistance to antimicrobials used for the treatment of HIV, TB and malaria,” he said.
Dr Siyoi said individuals seeking over-the-counter antibiotics for self-treatment, inappropriate prescribing of antibiotics to treat viral infections and antibiotic overuse and misuse are the major causes of AMR globally and even in the country.
When used appropriately, antimicrobials could protect patients from potentially fatal infections and improve patient outcomes in complex procedures such as surgery and in the administration of chemotherapy in immune-compromised individuals.
“Action to confront and overcome the problem must be taken now. Policies already exist and some are being formulated at international, regional and national levels,” he said, adding the board has published new rules on the disposal of pharmaceutical waste to ensure public safety.
