Title: Antibiotic dispensing practices and antimicrobial stewardship gaps in community pharmacies in Kakamega County, Kenya
Authors: Turnbull-Jones E, Langtree S, Mogoi N, Sifuna A, Gadaffi L, Jewell T.
Journal: ,: (2026)
Abstract
Abstract
Background
Antimicrobial resistance (AMR) is a major global health threat, with sub-Saharan Africa bearing a disproportionate burden. Community-level antibiotic dispensing practices remain poorly described in Kenya outside Nairobi.
Methods
A total of 504 antibiotic dispensing events were prospectively recorded across 22 community pharmacies in Kakamega County, western Kenya, between 3rd and 22nd August 2025. Data collected included dispensing source (over-the-counter [OTC] versus prescription), clinical indication, antibiotics dispensed, course completion, and self-reported repeat antibiotic use within the preceding month. Descriptive analyses were performed, and ?
2
tests were used to examine associations between dispensing source and selected non-antibiotic dispensing characteristics.
Results
Of the 504 dispensing events, 224 (44.4%) involved OTC dispensing and 278 (55.2%) were prescription-based. The most frequent indications for antibiotic dispensing were upper respiratory tract infections (URTI; n = 156, 31.0%), lower respiratory tract infections (LRTI; n = 95, 18.8%), gastrointestinal infections (n = 65, 12.9%), and skin or soft-tissue infections (n = 55, 10.9%). Across all events, amoxicillin, azithromycin, and metronidazole were the most frequently dispensed antibiotics, with broad-spectrum agentsâincluding fluoroquinolones and cephalosporinsâcommonly used for lower respiratory tract infections, urinary tract infections, and sepsis. Partial antibiotic courses were supplied in 33 (6.5%) dispensing events, most commonly due to financial constraints (15/33, 45.5%). Self-reported antibiotic use within the preceding month occurred in 156 (31.0%) cases.
Conclusions
OTC antibiotic access remains widespread in Kakamega County, with substantial use of broad-spectrum agents across multiple clinical indications. Financial barriers contribute to incomplete antibiotic courses. These findings highlight the importance of incorporating community pharmacy dispensing data into county-level antimicrobial stewardship programmes and informing national strategies to optimise antibiotic use.