Fiona Kanini was clearly in distress as she walked to the local chemist near her home in Umoja Two, in the populous Eastlands region of Nairobi County.
“My baby had been coughing for two days and despite giving her paracetamol, her fever and discomfort had not yet subsided. I went to the chemist to get some stronger medication that my neighbours had talked about, hoping the cough would clear up as soon as possible.
After she had asked whether the cough syrup was available, the chemist, a trained pharmacist, asked her how old the baby was.
“When I told him Baby Shantelle was three months old, he was gentle but firm in his response,” the 24 year old mother of one recounted.
“Your baby is a little too young to get such a powerful antibiotic. Please visit the clinic or health centre for a proper examination and diagnosis of the issue before any medicines can be given,” he told her.
She visited a nearby health facility as advised. Her baby’s cough was resolved after the medics diagnosed the illness and recommended the appropriate treatment.
“The doctor was happy that I had spoken to the right pharmacist who prioritized my baby’s health over the need to make a quick sale. I was told to avoid buying antibiotics over the counter because they can lead to resistance if overused,” she told Afya Watch.
Antibiotic resistance is a ticking time bomb in global health, and nowhere is the threat more pronounced than in low- and middle-income countries (LMICs) like Kenya.
Antibiotics are often overprescribed to children, fuelling a crisis that could render these life-saving drugs useless. But two groundbreaking studies offer a glimmer of hope, revealing a dual strategy that could turn the tide: combining vaccines with smarter prescribing practices.
The Root of the Problem
Diarrhoea is one of the leading causes of childhood illness in LMICs, but it’s also one of the most misunderstood. Children in low and middle-income countries are routinely prescribed antibiotics for diarrhoea, even though most cases are caused by viruses or parasites – not bacteria, which antibiotics are designed to treat. Research by Elizabeth T. Rogawski McQuade and her team reveals a concerning pattern: for every 100 child years, 135 antibiotics were prescribed for diarrhoea, but only 34 of these prescriptions were justified by actual bacterial infections. This widespread misuse of antibiotics not only wastes medicine but also contributes to the growing threat of antibiotic resistance.
Healthcare workers often prescribe unnecessary antibiotics due to multiple challenges. Without proper diagnostic equipment, they must rely on educated guesses. Many err on caution, prescribing antibiotics as a preventive measure to avoid missing potentially dangerous bacterial infections. The problem is further complicated by parents who, anxious to see their children recover quickly, actively seek antibiotic prescriptions. This combination of limited resources, cautionary prescribing, and patient pressure drives the cycle of antibiotic overuse.
What the VIDA Study Revealed
The Vaccine Impact on Diarrhea in Africa (VIDA) project paints a similar picture. Researchers looked at antibiotic prescribing practices for children aged 2 to 59 months in Kenya, The Gambia, and Mali, and found alarmingly high rates of inappropriate prescriptions. In Kenya, for instance, children with fever were far more likely to receive antibiotics than their counterparts in The Gambia, even when the drugs weren’t needed.
One striking finding was the link between certain symptoms and antibiotic overuse. Children with a cough or signs of dehydration were significantly more likely to be given antibiotics, regardless of whether a bacterial infection was present. This points to a worrying gap: healthcare workers are often unsure when antibiotics are truly necessary.
What About Vaccines?
Vaccines offer a promising solution to this problem. According to Rogawski McQuade’s research, developing vaccines against major diarrheal pathogens – including Shigella, E. coli, and rotavirus – could significantly reduce antibiotic use. Research shows a Shigella vaccine could prevent eight unnecessary antibiotic prescriptions for every 100 children treated in a year.
The benefits extend beyond targeting specific infections. Vaccines would help healthcare workers make more confident diagnoses by reducing the overall number of diarrheal cases. With fewer patients presenting with diarrheal symptoms, doctors would face less pressure to prescribe antibiotics as a precautionary measure, ultimately helping curb antibiotic overuse.
A Blueprint for Change
- Strengthen Antibiotic Stewardship: Healthcare workers need better training on when—and when not—to prescribe antibiotics. Programs that educate clinicians about WHO guidelines and the risks of overuse are essential.
- Update Clinical Guidelines: Existing protocols often don’t reflect the realities in LMICs. Revising guidelines to better align with local disease patterns and resistance trends can help healthcare workers make smarter decisions when prescribing antibiotics.
- Educate Caregivers: Parents often demand antibiotics because they believe they’re a quick fix. Public awareness campaigns can help them understand that antibiotics aren’t always the answer—and misuse can have serious consequences.
- Build Better Monitoring Systems: Regular audits of prescribing practices can highlight problems and guide targeted interventions. Real-time feedback for healthcare workers can drive lasting change.
- Invest in Diagnostics and Health Systems: Rapid diagnostic tools can help healthcare workers identify bacterial infections more accurately, reducing unnecessary prescriptions. Strengthening health systems to ensure access to these tools is critical.
As the world grapples with the growing threat of antibiotic resistance, this dual approach offers a roadmap for change. By combining vaccines with improved prescribing practices, we can ensure that children in LMICs receive the care they need—without fuelling a global health crisis.
This article is based on the studies “Eliminate prescribers’ uncertainty to catalyse the impact of vaccines on antibiotic use” by Brecht Ingelbeen et al., published in The Lancet Global Health, and the Vaccine Impact on Diarrhea in Africa (VIDA) project. The full text is available under the CC BY-NC-ND 4.0 license.
