DRUG RESISTANCE MENACE
countries due to overuse of antibiotics, widespread availability of counterfeit or substandard medicines
and poor infection prevention and control measures.
Anti microbial resistance (AMR) pathogens already claim 700,000 lives each year, worldwide and
thousands of lives are being claimed in Kenya due lack of effective drugs. (Andrew Jacob et al 2019).
thousands of lives are being claimed in Kenya due lack of effective drugs. (Andrew Jacob et al 2019).
Research shows that a continued rise in AMR could lead to 10 million deaths every year and
a 3% reduction in gross domestic product by the year 2050 (Global health CDC-Kenya 2018).
Researchers have discovered a high prevalence of antibiotic resistant bacteria in the East Africa nation
due to over-use of antimicrobial agents (Naval Research laboratory 2017). “Antimicrobial resistance (AMR)
within a wide range of infectious agents is a growing public health threat of broad concern to countries
and multiple sectors.
a 3% reduction in gross domestic product by the year 2050 (Global health CDC-Kenya 2018).
Researchers have discovered a high prevalence of antibiotic resistant bacteria in the East Africa nation
due to over-use of antimicrobial agents (Naval Research laboratory 2017). “Antimicrobial resistance (AMR)
within a wide range of infectious agents is a growing public health threat of broad concern to countries
and multiple sectors.
Increasingly, governments around the world are beginning to pay attention to a problem so serious that
it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections
and minor injuries can kill.” (WHO 2014). Research found out that 90% of people in Kibera slum have
used antibiotics as compared to 17 percent for a typical American family (Andrew et al 2019)
used antibiotics as compared to 17 percent for a typical American family (Andrew et al 2019)
Antibacterial resistance–associated infections are known to increase morbidity and mortality and cost
of treatment and to potentially put others in the community at higher risk of infections
of treatment and to potentially put others in the community at higher risk of infections
WHO reports gram negative to be increasingly developing antibiotic resistance as compared to
gram positive.
gram positive.
According to a 2010 demographic and health survey collected, Kenya has made tremendous
improvement in the health sector shown by reduced mortality rates and accessibility of health care
including lifesaving antibiotics. This was rare in the 19th century. Despite this achievement, disease
burden still remains high in Kenya. The combination of having access to medication and increased
demand for antibiotic treatment has invited another burden of drug resistance which is turning to be lethal.
improvement in the health sector shown by reduced mortality rates and accessibility of health care
including lifesaving antibiotics. This was rare in the 19th century. Despite this achievement, disease
burden still remains high in Kenya. The combination of having access to medication and increased
demand for antibiotic treatment has invited another burden of drug resistance which is turning to be lethal.
Around the world, bacterial pathogens are increasingly resistant to antibiotics. For instance,
the first generation of antibiotics is already of little use in many countries. To the worst, second and
third generation drugs are also losing effectiveness in low- and middle-income countries.
(Kenya situation analysis 2017)
the first generation of antibiotics is already of little use in many countries. To the worst, second and
third generation drugs are also losing effectiveness in low- and middle-income countries.
(Kenya situation analysis 2017)
Widespread use of tetracycline in livestock production, use of trimethoprim/sulfamethoxazole (SXT) and
chloramphenicol as first line therapeutics for typhoid, and prophylactic use of SXT in persons exposed to or
infected with human immunodeficiency virus (HIV) might have contributed to the high prevalence of resistance
in Kenya (Naval Research Laboratory 2017).
The abuse of antibiotics in Kenya represents an increasing global concern for the public health and
agriculture sector, which has so far been linked to resistance to some illnesses.
(Gerald Andae, business daily)
Due to increasing AMR global threat World health assembly resolution on AMR in 2014 paved the way to
development of WHO global action plan on AMR in 2015 which urged member states to make National action
plans for dealing with AMR.
Kenya ratified the resolution in 2016 and came up with the national policy and action plan on tackling
antibiotic resistance and the following resolutions were to:
Kenya ratified the resolution in 2016 and came up with the national policy and action plan on tackling
antibiotic resistance and the following resolutions were to:
- Creating awareness through communication, education and training
- Strengthening evidence base for tracking antimicrobial use and resistance through improved
- Reducing the incidence of infection to help reduce reliance on antimicrobial through effective sanitation,
- Hygiene and infection prevention measures;Optimizing antimicrobial use in human and animal health; and
- Developing an economic case for sustainable investment that takes into account the needs of the country
History of AMR surveillance in Kenya goes back to the late 1970s and early 80s when Kenyatta National
Hospital and University of Nairobi, College of Health Sciences began compiling and following antibiotic susceptibility patterns of routine clinical isolates.
Hospital and University of Nairobi, College of Health Sciences began compiling and following antibiotic susceptibility patterns of routine clinical isolates.
WHO 2014 and Samuel K. et al 2014 found out that 3rd generation cephalosporin had reduced efficacy on
treating Neisseria gonorrhea
In a recent cross-sectional study in Northern Uganda, gonococcal isolates (n = 151) showed decreased
susceptibility to ampicillin, tetracycline and erythromycin, and ciprofloxacin, and intermediate resistance
to chloramphenicol. Similarly, in a study in rural western Kenya investigating STIs in men from 2002 to 2009,
penicillin resistance was found in 65% of 168 isolates obtained from 142 patients and plasmid-mediated
tetracycline resistance in 97%, while 11% of the N. gonorrhoeae isolates were ciprofloxacin resistant.
This study also noted that quinolone-resistant N. gonorrhoeae first appeared in 2007, increasing from 9.5%
in 2007 to 50% in 2009 (Samuel K. et al 2014)
in 2007 to 50% in 2009 (Samuel K. et al 2014)
WHO 2014 also reported 3rd generation cephalosporins and fluoroquinolones to have reduced efficacy in
treating Escherichia coli infection.
treating Escherichia coli infection.
The research done by C. Ndungu et al at Thika level 5 Hospital in 2014 on Susceptibility of E.coli on drugs
found out the following results: in aminoglycosides were, resistance for amikacin, gentamicin and kanamycin
was 20%, 39% and 51% respectively. Resistance in penicillin was ampicillin 85% and piperacillin 83%.
Resistance for sulfamethoxazole was 83%, tetracycline 66 %, nalidixic acid 44 % and chloramphenicol 39%.
found out the following results: in aminoglycosides were, resistance for amikacin, gentamicin and kanamycin
was 20%, 39% and 51% respectively. Resistance in penicillin was ampicillin 85% and piperacillin 83%.
Resistance for sulfamethoxazole was 83%, tetracycline 66 %, nalidixic acid 44 % and chloramphenicol 39%.
In amoxicillin/clavulanic acid, resistance was 68%. Cephalosporins’ resistance was ceftazidime 22 %,
56 %. Resistance for imipenem and tazobactam was 7% and 12 % respectively.
In other studies, 71% Staphylococcus aureus isolates from Kenya have demonstrated multiple drug resistance.
In Uganda, resistance to Ampicillin, Amoxicillin and Chloramphenicol has been documented.
Staphylococcus aureus, Pseudomonas aeruginosa, Proteus mirabilis are reportedly multidrug resistant.
In Ethiopia, the situation is very dire. Gonococcal strains have been found to be multidrug resistant.
“We are seeing high resistance of common pathogens to antibiotics such as 98 percent of
fluoroquinolone-resistant Escherichia coli, meaning that treatment options for people with infections are becoming increasingly limited,”
fluoroquinolone-resistant Escherichia coli, meaning that treatment options for people with infections are becoming increasingly limited,”
(Rudi Eggers- WHO representative)
Although overuse of and misuse of antimicrobial have contributed to the emergence and spread of resistance,
paradoxically, under-use through lack of access, inadequate dosing, poor adherence, and substandard
antimicrobial, lack of knowledge, access and self-medication with antibiotics, lack of diagnostics tool and
fear of negative outcome of treatment. may play an equally important role. And of course, complete lack
of access can mean death, especially for infants and children. A great hindrance to solving this problem is
difficulties in implementing guidelines and policies usually as a result of lack of regulatory authority and
insufficient resources for enforcement. ( GARP-Kenya, 2011)
antimicrobial, lack of knowledge, access and self-medication with antibiotics, lack of diagnostics tool and
fear of negative outcome of treatment. may play an equally important role. And of course, complete lack
of access can mean death, especially for infants and children. A great hindrance to solving this problem is
difficulties in implementing guidelines and policies usually as a result of lack of regulatory authority and
insufficient resources for enforcement. ( GARP-Kenya, 2011)
Kenya has developed different guidelines and policies for treating different conditions which are readily
available online.
Declining private investment and lack of innovation in the development of new antibiotics are undermining efforts
to combat drug-resistant infections, says the World Health Organization (WHO)
to combat drug-resistant infections, says the World Health Organization (WHO)
For effective disease management, GARP kenya suggested the following measures to be put in place :
1. Proper Surveillance and monitoring system
2. Training and education,
3. Vaccination.
4. Quality control and supply chain improvements
5. Veterinary use of antibiotics.
2. Training and education,
3. Vaccination.
4. Quality control and supply chain improvements
5. Veterinary use of antibiotics.
References
Naval Research Laboratory. "High prevalence of antibiotic resistance in Kenya." ScienceDaily. ScienceDaily, 11 July 2017
Naval Research Laboratory. "High prevalence of antibiotic resistance in Kenya." ScienceDaily. ScienceDaily, 11 July 2017
New Yolk Times 2019.
Donkor ES et al, ‘community acquired urinary tract infections among adults in Accra Ghana,’ 2019
GARP Kenya, situation analysis and recommendations ‘Antibiotic Use and Resistance in Kenya’ August 2011.
Global health kenya. CDC kenya, ‘Strengthening Antimicrobial Resistance Surveillance.’ 2018
Jay K et al, “Africa Centres for Disease Control and Prevention's framework for antimicrobial resistance control
in Africa,” Africa Journal of laboratory medicine 2002.
(M. Mendelson, P. Matsoso, Kenya’s perspective on antibiotic resistance 2017)
WHO, ‘antimicrobial resistance: global report on surveillance,’ 2014.
http://www.health.go.ke/misuse-of-antibiotics-a-risk-to-health-food-and-development/
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