Dispensing of antimicrobials in Kenya: a cross sectional pilot study and its implications

Objectives: Irrational use of antibiotics is a major driver of antimicrobial resistance, enhanced by inappropriate prescribing and dispensing of antibiotics. Little is currently known about dispensing of antibiotics in Kenya including self-medication with antibiotics. Consequently, the objective was to evaluate the extent of self-medication of antibiotics and dispensing practices in Kenya. Methods: Cross sectional study among 3 randomly selected community pharmacies in Nairobi. Findings: There was a low level of dispensing of antibiotics without a prescription with over ninety percent (94.1%) of antibiotics dispensed with a valid prescription. The most common antibiotics dispensed were the penicillins at just over fifty percent of all antibiotics, the cephalosporins at over twelve percent (12.6%) and the fluoroquinolones at just under twelve percent (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. Encouragingly, antibiotics were not dispensed for influenza or a common cold, and generally very good dispensing processes, with typically a good level of medication history and counselling. 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.