Alarm over rising drug resistance

• Doctors say there is an emerging trend where medicines that have been prescribed to patients for decades, especially antibiotics, no longer work. The tragedy is that even livestock have developed resistance, and meat samples show high levels of harmful chemicals that may find their way to your plate and into your body

“Retail prices in the private sector are more than three times the international reference price for the lowest priced generic, and nearly 17 times the international reference price for the most expensive innovator brands,” says the study of the fleecing of patients in local private hospitals.

In district hospitals, the team says nearly 71 per cent of the antibiotics prescribed for pneumonia should have been for severe cases and only 16 per cent should rightly have been put on such a regimen.

Half of the children in western Kenya diagnosed with pneumonia or measles were found to have been wrongly put on chloroquine, a malaria medicine, while many cases of malaria had been wrongly put on penicillin.

“Almost all recommended antibiotics for dysentery were incorrect.”

The rate of misinformation among health workers was alarming, raising questions about the quality of medical training in Kenya. Over 70 per cent of medical workers, for example, said antibiotics effectively kill viruses that cause diarrhoea.

Poor Kenyans in Nairobi were found to be unable to afford the full prescription, prematurely ending treatment when symptoms subside.

Sharing of medication among family members and friends and hoarding drugs for future use were also identified as contributory factors to growing drug resistance.

A spot check carried out by this newspaper in Nairobi found that some pharmacies split doctors’ prescriptions and dispense only what the patient can afford in the hope that they will come back later for the remainder. However, no records are kept for such transactions, making patient follow up difficult even for chronic diseases.

“Retail pharmacies, frequently operating without a licence, appear to be more accessible to patients. They are located within the community, do not charge consultant fees, have shorter waiting times, and are willing to negotiate treatment protocols to meet the financial needs of clients,” says the study.

More than a third or Nairobi residents use retail pharmacies as their first site for outpatient care, according to Dr Kariuki.

Some pharmacies were found to hold commercial contracts with physicians or are physician-owned. Therefore, the clinicians derive direct financial benefits from drug prescriptions and sales.

The researchers also cast doubt on the quality of antibiotics being dispensed in Kenya, saying there are indications that 30 per cent of the products in the market would not meet the necessary potency tests.

The report indicates poor storage facilities at hospitals and antibiotics stock-outs lasting for up to three months. For the nyama choma crowd, there is an even bigger risk of ingesting meat with high levels of antibiotic residues.

Also detected are significant levels of antibiotic residues in milk, mainly because of indiscriminate use of anti-mastitis drugs by small-scale farmers who supply much of the unpasteurised milk in Nairobi.

“Penicillin is the most common residue in milk, with levels often exceeding the allowable limits two-fold, while tetracycline is the most commonly used antibiotic in rearing chicken.”

Significant drug resistant bacterial strains were also identified in pigs, with the researchers expected to make far reaching recommendations on the rational use of antibiotics in the next few months.