Widespread empirical antibiotic use among Nairobi cough patients

Antibiotic misuse is a global problem that helps drive antimicrobial resistance (AMR), which the researchers note contributes to an estimated 1.27 million deaths worldwide. In Kenya, patterns of antibiotic use are influenced by how people seek care and by social and economic factors, but little has been known about adults who present with productive coughs — a common symptom that can signal infections such as tuberculosis or other respiratory illnesses. To fill that gap, a team led by corresponding author Alvin Kinji Mwabu carried out a study in Nairobi County focused on people attending selected chest and tuberculosis clinics. The study was a facility-based cross-sectional survey of 400 adults aged 18 and above who had productive coughs. Using a structured questionnaire, the research collected information on sociodemographic characteristics, where and how people sought antibiotics, and patterns of antibiotic use. The aim was to map the pathways patients took to obtain antibiotics and to identify how factors like income, education, gender, smoking history, and past tuberculosis influenced those choices.

The study found that most participants were male (65.0%) and employed (67.0%), while 68.3% reported monthly earnings below Ksh 10,000 (about USD 80) and 35.8% had basic education. Histories of smoking (37.3%), tuberculosis (32.0%), or other comorbidities (29.8%) were common. Of the 400 people surveyed, 347 (86.7%) reported using antibiotics. Among those users, 46.4% obtained antibiotics via general practitioners (GP) only, 31.4% used both GP and over-the-counter (OTC) sources, 15.3% relied on OTC only, and 6.9% obtained antibiotics by self-medication. Women were more likely to self-medicate (13.3% versus 3.2% for men) and had higher odds of antibiotic use (cOR: 2.00; 95% CI: 1.04–4.10). People with a history of tuberculosis were more likely to rely on GPs (61.7% versus 37.4%). Low-income participants mainly used GP-only sources, while higher-income earners favored GP plus OTC routes (RRR: 2.67; 95% CI: 1.41–5.05). Antibiotic use was largely empirical (71.1%), dominated by Amoxicillin (90.8%), with frequent use of Amoxicillin/Clavulanic acid and 67.2% reporting multiple antibiotic use.

These findings point to widespread, largely empirical antibiotic use among adults with productive coughs in Nairobi clinics, with Amoxicillin and Amoxicillin/Clavulanic acid prominent in treatment. The mix of formal GP prescribing and OTC access, plus a notable level of self-medication, shows gaps in how antibiotics are regulated and used in practice. Sociodemographic patterns — including gender differences, income effects, and prior tuberculosis history — influence where people get antibiotics and how they use them. That combination raises concerns because empirical and multiple antibiotic use, especially when done without testing or clear prescriptions, can accelerate the development of AMR and undermine efforts to treat infections effectively. The study’s authors highlight the need for stronger enforcement of prescription rules and for beefed-up antibiotic stewardship efforts in clinics and communities to promote rational use. In short, without clearer controls on access and better programs to guide prescribing and public behavior, these patterns of use could worsen antibiotic resistance and make infections harder to treat.