New York Times: In a Poor Kenyan Community, Cheap Antibiotics Fuel Deadly Drug-Resistant Infections

9 April, 2019

Dear HIFA colleagues,

Below are extracts from a news article in the New Yoprk Times. It describes vividly how poor sanitation and easy access to antibiotics drive antimicrobial resistance, which in turn drives rampant use of antibiotics as people try one after another, often without completing the course. And "a billion people are living in similar situations".

Full text here: https://www.nytimes.com/2019/04/07/health/antibiotic-resistance-kenya-dr...

NAIROBI, Kenya — Four days after her toddler’s health took a turn for the worse, his tiny body racked by fever, diarrhea and vomiting, Sharon Mbone decided it was time to try yet another medicine.

With no money to see a doctor, she carried him to the local pharmacy stall, a corrugated shack near her home in Kibera, a sprawling impoverished community here in Nairobi. The shop’s owner, John Otieno, listened as she described her 22-month-old son’s symptoms and rattled off the pharmacological buffet of medicines he had dispensed to her over the previous two weeks. None of them, including four types of antibiotics, were working, she said in despair.

Like most of the small shopkeepers who provide on-the-spot diagnosis and treatment here and across Africa and Asia, Mr. Otieno does not have a pharmacist’s degree or any medical training at all. Still, he confidently reached for two antibiotics that he had yet to sell to Ms. Mbone.

“See if these work,” he said as she handed him 1,500 shillings for both, about $15.

Antibiotics, the miracle drugs credited with saving tens of millions of lives, have never been more accessible to the world’s poor, thanks in large part to the mass production of generics in China and India. Across much of the developing world, it costs just a few dollars to buy drugs like amoxicillin, a first-line antibiotic that can be used against a broad range of infections, from bacterial pneumonia and chlamydia to salmonella, strep throat and Lyme disease...

Kibera residents are prodigious consumers of antibiotics. One study found that 90 percent of households in Kibera had used antibiotics in the previous year, compared with about 17 percent for the typical American family...

In fact, urban poverty is a huge and largely unappreciated driver of resistance. And so, the rise of resistant microbes is having a disproportionate impact on poor countries, where squalid and crowded living conditions, lax oversight of antibiotic use and a scarcity of affordable medical care are fueling the spread of infections increasingly unresponsive to drugs.

“We can’t effectively mitigate the growing problem of antibiotic resistance without dealing with places like Kibera,” said Dr. Guy H. Palmer, a researcher at Washington State University who studies resistance in Africa. “There are a billion people living in similar situations, and as long as they aren’t getting clean water and basic sanitation, all of us are at risk.”...

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Best wishes, Neil

Joint Coordinator HIFA Project on Information for Prescribers and Users of Medicines

http://www.hifa.org/projects/prescribers-and-users-medicines

Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org

HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org