Dispensing of Antimicrobials in Kenya: A Cross-sectional Pilot Study and Its Implications

Objective: The objective of this study was to evaluate the extent of self-medication of antibiotics and dispensing practices in Kenya. Methods: A cross-sectional study was carried out at three selected pharmacies in Nairobi (Kenya), between January and March 2017, targeting principally antibiotic prescriptions for systemic use issued and dispensed as well as antibiotics sold over-the-counter without a prescription. The quality of antibiotics prescribed and dispensed was assessed against key WHO and other criteria. Benchmarking was used to assess the quality of antibiotics prescribed as there are no predetermined levels, just guidance and the rationale. Key indicators included: utilization of penicillins, percentage utilization of third-and fourth-generation of cephalosporins versus first and second generation, utilization of macrolides including lincosamides and utilization of quinolones as a percent of total systemic antibiotic use. Findings: There was a low level of dispensing of antibiotics without a prescription with over 90% (94.1%) of antibiotics dispensed with a valid prescription. The most common antibiotics dispensed were the penicillins at just over 50% of all antibiotics, the cephalosporins at over 12% (12.6%) and the fluoroquinolones at just under 12% (11.7%). There were concerns with high use of third and fourth generation cephalosporins versus first-and second-generation as well as co-amoxiclav versus other penicillins. Conclusion: Low levels of self-medication of antibiotics and high adherence to quality standards for dispensing are encouraging and provide direction to other countries. Educational initiatives are needed though to address high levels of co-amoxiclav prescribing.