Antibiotics resistance and the race to stop deaths

Kenya Medical Association chairperson Dr Jacqueline Kitulu during the interview in her KMA office Upper Hill on 28/04/16. (PHOTO: JENIPHER WACHIE/ STANDARD)

Loise Kinuthia does not know it yet but she is to blame. The same goes for Rehema Adan.

Both Loise and Rehema are dedicated mothers. That they cherish motherhood is not in question. They like to think, and rightfully so, that they are the best mothers in the world. Nevertheless their contribution to human deaths — now and in the future — lurks nearby.

How? You may ask. As it turns out, the mishaps they have committed in administering medicine to their children and themselves has contributed to the rise of medicine defying pathogens.

Loise admits to missing antibiotic dosage for her son. Not once or twice but uncountable times.

“When my son shows signs of improvement from an illness I tend to be satisfied,” she says with a nonchalant smile, “and may forget for a day or even two, to complete the dosage.”

When Rehema’s son has fever, or any other suggestive symptom, she makes a quick dash to the chemist outside the estate and gets medicine from over the counter.

The manner in which Rehema talks about her penchant for over the counter drugs puts to her ignorance of the matter.

“Children are prone to sicknesses. They easily suffer from fevers and colds. Instead of spending so much money visiting a pediatrician, who will just prescribe antibiotics, I buy the medicine myself and save myself the hassle,” she says.

They still do not know it but Loise and Rehema have participated in the rise of superbugs which are bacteria that are resistant to drugs typically used to kill them.

Superbugs, aside from making life unbearable through illness, have caused deaths in the millions.

A recently released report by a review team has projected a surge in deaths caused by antimicrobial resistance (AMR). The review was established in 2014 by the British government.

The report warns that 10 million people could die every year by 2050 from diseases caused by pan-drug-resistant germs, the so called superbugs. Of the 10 million, nearly 4.1 million will be in Africa.

Infectious diseases that were hitherto curable with simple antibiotic arsenal are now resistant to the best performing drugs antibiotic technology has provided over the centuries.

And there is no one else to blame except humans. From the doctor who makes the wrong diagnosis to the mother who self-medicates her household without professional opinion.

“Antibiotics resistance is on a rising trend,” warns Dr Jacqueline Kitulu, chairperson of the Kenya Medical Association.

Patients not completing their course of antibiotics greatly contribute to antibiotic resistance.

According to Kitulu: “Bacteria are not cleared completely when dosage is not adhered to. The surviving bacteria then mutate against the antibiotic which creates variants that can withstand such medicine.”

It should, however, be known that bacteria has a propensity to outlast existing medicine, argues Dr Sam Kariuki, director at Centre for Microbiology Research within Kemri.

That notwithstanding, he says, there is an increase in use of over the counter medicine for drugs not issued under prescription.

This is where it gets tricky, Kitulu says. “Pharmacists should not be giving medicine without prescription from a doctor. Many go ahead and sell medicine to clients because it is a business. That is wrong because it often leads to use of wrong medicine to treat an illness,” she says.

Doing so undercuts the function of such enterprises yet doctors are also to blame for misdiagnosing infections.

“Antibiotics are strictly for use against bacteria. They are not for use against viruses. And since some viral diseases exhibit similar symptoms as bacterial diseases, if proper testing is not carried out and the practitioner assumes diagnosis it could end up as a misdiagnosis,” Dr Kitulu adds.

There are no statistics available on the number of times antibiotics are wrongly prescribed by medical practitioners. But perhaps England’s estimation of 10 million unnecessary antibiotic prescriptions every year could be a pointer.

Kenya lacks statistics on the number of deaths caused by antimicrobial resistance. However, World Health Organisation (WHO) estimates that 700,000 lives are lost each year to bugs that refuse to respond to even the last line of drugs.

Among drug resistant infections plaguing the country is Multi-drug resistant Tuberculosis (MDR-TB).
Statistics from the Ministry of Health show that by November 2015, 305 cases of MDR-TB had been reported in Kenya. This indicates an alarming increase from 82 cases recorded in 2006.

WHO believes that at least 2,750 Kenyans are infected with MDR-TB every year but many cases go undetected and unreported.

“The increase in MDR-TB could be because we are using better diagnostic technologies now. But drug resistance is also a reality. MDR-TB did not exist some years back. So, MDR-TB is the result of antibiotic resistance,” observes DR Evans Amukoye, a TB researcher at Kemri.

According to Director of Medical Services Dr Nicholas Muraguri, Kenya is using Sh1 billion to treat more than 500 Kenyans who have drug-resistant strains of Tuberculosis.

The current treatment regimen in place for TB consumes Sh8,000 per patient and lasts six months. To treat a patient with MDR-TB however costs Sh2 million and the treatment lasts 24 months.

Many pundits are worried that the rise of antimicrobial resistance will herald a difficult time in the history of humanity. If nothing is done to curtail the trend more lives will find themselves at the mercy of microscopic organisms that cannot be stopped.

Also, performing simple surgical procedures – like caesarian section – will be difficult since infections would be fatal due to a lack of effective antibiotics.

And yes, if no action is taken, AMR will claim more lives than cancer and diabetes combined by 2050.

“It has to be a big concern. It is a silent problem that has not hit us in the face yet,” Ghada Zoubiane, programme manager for infection at the Medical Research Council in the UK told the media recently.

But there are other factors outside doctors’ control that are contributing to AMR. According to CDC, agricultural use of antibiotics on animals contribute to the emergence, persistence and spread of resistant bacteria.

Such animals serve as a reservoir of resistant pathogens and resistance mechanisms that can directly or indirectly result in antibiotic resistant infections in humans.

From the look of things, the war against antibiotic resistant germs has just began. Dr Kariuki believes that population pressure will exacerbate AMR as challenges with sanitation are a sure cause of trouble.

Researchers at the University of Leeds are working on technologies to easily and accurately diagnose infections.

Dr Kitulu on her part believes that a holistic approach, involving patients, governments, healthcare practitioners – to antibiotic resistance would be the only sure way to find solutions.