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Antibiotics resistance adds to Kenya’s infectious disease burden

Resistance develops when bacteria undergo some form of change that offer them protection or shield them from the effects of drugs. PHOTO | FILE
Resistance develops when bacteria undergo some form of change that offer them protection or shield them from the effects of drugs. PHOTO | FILE 

Magdalene Muema is a sad mother. She lost two of her children to pneumonia and diarrhoea, which persisted despite numerous attempts at treatment.

Two years have since passed, but she is still suffering from the ordeal. “I see other mothers carrying their children and I cry. It’s like I am the only one in pain when everyone else is happy,” said Ms Muema when the Business Daily spoke to her.

Unknown to Mary, more and more Kenyans – just like her children – are now succumbing to previous treatable infections as the germs that cause the diseases become increasingly resistant to antibiotic drugs aimed at destroying them.

The World Health Organisation (WHO) has blown the whistle over the emergence of drug-resistant bacteria that are rapidly spreading across the globe, threatening the world’s ability to treat common infectious diseases.

It notes that an increasing number of infections such as pneumonia, tuberculosis, drug poisoning and gonorrhoea are now becoming harder and sometimes impossible to treat as antibiotics become less and less effective.

Because of the severity of the problem, the antibiotics resistance problem has been elevated to the top of the global agenda. For the first time ever, world leaders and global health experts convened at the United Nations General Assembly in New York – in September - to discuss and set targets for eliminating this global health challenge.

Without urgent action to curb resistance, health experts warn that the world risks going back to the “dark” days experienced before the development of the first antibiotic by Alexander Fleming in 1928.

Back then, life expectancy was low and people died of common infections and minor injuries.

Antibiotic resistance also puts the achievements of modern medicines at risk. Organ transplants, chemotherapy for cancer and life-saving surgeries will become much more dangerous without effective antibiotics to prevent and treat infections associated with these procedures.

Prof Samuel Kariuki, Director of the Centre for Microbiology Research at the Kenya Medical Reserach Institute (Kemri), notes that nearly all bacteria responsible for the infectious disease burden in Kenya have developed some degree of resistance against antibiotics aimed at treating them.

“So this problem of resistance is real. We aren’t talking about things that will happen in the future. We already have the problem here,” Prof Kariuki said.

A 2015 study published in the Clinical Infectious Disease journal showed that common food-borne germs (E.coli, salmonella and campylobacter) in the country had developed resistance to common antibiotics used to treat them.

These germs cause severe diarrhoea and a broad spectrum of abdominal complications that are now becoming difficult for health experts to manage.

Another study published in the Journal of Antimicrobial Chemotherapy found that a bacterium known as streptococcus pneumoniae, one of the major causes of severe pneumonia in the country, had become less sensitive to oral penicillin antibiotics aimed at killing them.

The country is also grappling with drug-resistant tuberculosis among adult populations, especially those infected with HIV.

Blood stream infections caused by resistant bacteria such as Klebsiella and Acinetobacter are also increasingly killing children and adults with compromised immunity.

Resistance develops when bacteria undergo some form of change that offer them protection or shield them from the effects of drugs meant to destroy them.

This is a process that is inevitable. Like other living organisms, bacteria are continuously trying to find remedies to problems that affect them, just as human beings are constantly looking for solutions to challenges that threaten their existence.

As such, resistance itself isn’t the problem. Instead, health experts have an issue with the rapid rate at which the resistance is happening globally.
Organisms usually take a long time to develop resistance to existing drugs.

This duration gives scientists ample time to develop new varieties of antibiotics, with ingredients that can effectively destroy emerging “hard-core” bacteria.

So if the current trend of antibiotic resistance is not forestalled, health experts fear a time might come when there will be no effective drug in the market.

“And this can happen really fast since resistant bacteria can rapidly spread from one person to another,” said Prof Kariuki who is also the chairman of the Global Antibiotic Resistance Partnership (GARP) in Kenya.

He notes that a major cause of this rapid resistance is the overuse and misuse of antibiotics. Health practitioners commonly recommend these drugs for the treatment of infections —especially colds and flu —that do not require antibiotics since they are mainly caused by viruses and not bacteria.

He noted that pharmacies allowing over-the-counter access of antibiotics without medical prescriptions are also contributing to the abuse of antibiotics.

The overuse of the drugs is discouraged as it increases the exposure or interaction of bacteria to existing antibiotics. This makes it easier for the bugs to “study” the drugs and devise ways of resisting their toxic effects.

Prof Kariuki said the incomplete drug doses also breed resistance by exposing bacteria to minimal amounts of antibiotics. This makes it easier for the bugs to overpower the drugs and develop resistance towards them.

“This is why you should always finish your drug doses, even if you’re no longer feeling ill,” he said.

Sub-standard drugs also expose bacteria to less active ingredients of antibiotics thus promoting resistance.

Dr Kipkerich Koskei, head of the Kenya Pharmacy and Poisons Board (PPB), said that the institution conducts continuous monitoring and spontaneous raids to hunt down pharmacies or chemists selling substandard drugs, which operate mostly in the outcasts of the city.

“We are also doing the much we can to hold to account those selling antibiotics without prescriptions. But it’s a hurdle as the existing penalties are weak. So we are working hard to have them revised.”

Since drug molecules used in making antibiotics for both animals and human beings are the same, misuse or abuse of these drugs in the livestock sector (especially for growth promotion) leads to an influx of drug-resistant bacteria which are passed to humans through animal products like meat and milk.

“We share the same environment with animals. So the opposite can happen. We can also spread resistant organisms that we harbour to animals,” said Prof Erastus Kangethe, a lecturer of Veterinary and Public Health at the University of Nairobi.

“Therefore the health and livestock ministries have to work together to effectively tackle this problem of antibiotic resistance,” Prof Kang’ethe added.

To minimise the use of antibiotics and hence prolong their efficacy, the WHO calls for an increased uptake of vaccines that offer protection against a myriad of bacterial infections such as pneumonia and meningitis.

It also advocates for safe drinking water, proper sanitation and hygienic living conditions to halt the rise of bacterial infections.

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