# The appropriateness of empirical antibiotic therapy in the management of symptomatic urinary tract infection patients—a cross-sectional study in Nairobi County, Kenya

## TL;DR

This study assesses how well antibiotics prescribed without lab tests treat urinary tract infections in Nairobi, Kenya, finding that less than half of prescriptions matched the bacteria's resistance patterns.

## Contribution

The study provides insights into the effectiveness of empirical antibiotic prescriptions for UTIs in a low-resource setting with high antibiotic resistance.

## Key findings

- Only 53% of empirically prescribed antibiotics matched the susceptibility of isolated UTI pathogens.
- Fluoroquinolones were the most commonly prescribed antibiotics for UTI patients.
- Antimicrobial resistance surveillance is recommended to improve empirical treatment in resource-limited areas.

## Abstract

In low- and middle-income countries, symptomatic urinary tract infection (UTI) patients are often prescribed antibiotics without microbiological confirmation. UTIs caused by antibiotic-resistant bacteria are increasingly common, and this heightens the risk of empirical treatment failure. This study evaluates the appropriateness of empirical antibiotic therapy to UTI patients in Nairobi County, Kenya.

A hospital-based, cross-sectional study was conducted in Nairobi County, Kenya, amongst symptomatic adult and child patients. UTI was defined as a monoculture growth with colony counts of ≥104 cfu/mL. Antimicrobial susceptibility testing was performed by the Kirby–Bauer disc diffusion method. Empirical therapy was considered appropriate if the pathogen isolated was susceptible to the prescribed antibiotic and inappropriate if the pathogen was resistant to the prescribed antibiotic.

A total of 552 participants were enrolled with a median age of 29 years (interquartile range: 24–36). The majority were female, 398 (72%). Of the 552, 274 (50%) received empirical antibiotic therapy, and 95/274 (35%) were confirmed to have UTI by culture. The antibiotics most frequently prescribed were fluoroquinolones [ciprofloxacin in 80 (30%) and levofloxacin 43 (16%)], amoxicillin–clavulanic acid in 48 (18%) and nitrofurantoin in 32 (12%). Amongst the 95 patients with bacteriological confirmation of UTI, 50 (53%) received appropriate empirical antibiotic therapy, whilst for 38 (40%) participants, the therapy was inappropriate.

The complexity of appropriate empirical treatment for UTIs is compounded by high levels of resistance in UTI pathogens. Antimicrobial resistance surveillance strategies that could help in designing appropriate empirical regimens in resource constrained settings should be adopted for optimal empiric therapy.