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

Kenyans, like their livestock, are getting more difficult and costly to treat as a result of increased misuse of medicines. The situation has been worsened by incompetent and, in some cases, greedy heath care personnel.

Misuse of livestock medicines is so rampant that your favourite weekend nyama choma excursion may be more than just chomping on some heart-ruining fat; you could be gobbling chemicals whose effect on your body will be reflected in your next hospital bill.

In the animal kingdom, the worst affected are the popular Maasai plains as new evidence shows high residue levels of antibiotics in meat originating from Kajiado and Narok, from where most of the butcheries in Nairobi get their supplies.

“This is not just a medical earthquake, it is a tsunami,” says Dr Samuel Kariuki of the Kenya Medical Research Institute. “We are killing our medicines and, in the process, killing ourselves and our children.”

Dr Kariuki’s warning is supported by an 84-page situational analysis of antibiotic use and resistance in Kenya that shows that germs that have been easy to kill are fighting back — and winning — against administered antibiotics.

From the Maasai plains to the country’s hospitals, the bugs are waging a war that seems almost won and it is only a matter of time before the situation explodes out of control if nothing is done.

If you are admitted to Kenyatta National Hospital’s intensive care unit for more than two days, for instance, you are likely to acquire a new infection, mainly because of overcrowding and poor infection control.

What is happening at Kenyatta is only a tip of the iceberg. Typhoid, a common disease in Kenya that sometimes explodes into epidemics, is becoming almost impossible to treat.

Medical researchers say that only about 20 out of 100 patients are responding to five commonly used medicines in Thika and Embu districts, for instance.

Diseases such as gonorrhoea were easy to treat two decades ago — in fact, many referred to them as “a small bout of cold” — but these have now turned into medical nightmares. Then treated with a cheap dose of penicillin or tetracycline, gonorrhoea is now proving a veritable headache in the medical field and its treatment has become expensive.

Penicillin, once a wonder drug, has lost its magic even in the treatment of pneumonia, a major killer of children in Kenya. More than half of children with severe pneumonia are no longer responding to penicillin and a similar number of adult cases are not sensitive to the second- and third-line medications.

While a penicillin combination treatment for children would cost about Sh400 at Kilifi District Hospital, the alternative treatment goes for up to Sh5,000. The loss of penicillin’s viability in the medical field would be a major blow in Kenya, considering that it is the most prescribed antibiotic in the country because of its affordability and capacity to treat numerous bacterial infections.

So, what brought about this?

“Over-use, misuse, self-medication, wrong prescriptions, and over-the-counter sales of antibiotics have done us in,” says Dr Kariuki in his study, which involved researchers from Kemri, the Livestock Ministry, Kenyatta National Hospital, and the universities of Nairobi, Aga Khan, and Maseno.

Others were from the Ecumenical Pharmaceutical Network, the Pharmacy and Poisons Board, and the US Centres for Disease Control and Prevention.

The team blamed ignorant and greedy doctors and poor regulatory systems for the crisis. Those at most risk are patients with good medical insurance. They often get prescriptions for too many and unnecessary drugs and expensive second-line medicines.

“In some Nairobi hospitals, staff and consultant doctors within the same facility are held to different prescribing standards, depending on the amount of revenue they generate for the hospital,” says the study.

It was also found that the more expensive the drug was, the more likely the dispenser was to recommend it.