Published in PLOS One on 2026-05-15, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Eleanor Turnbull-Jones, Susannah Langtree, Nicholas Mogoi, Anthony Sifuna, Lindsay Gadaffi, Tony Jewell
Source: PLOS One • DOI 10.1371/journal.pone.0342353
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
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.
A total of 504 antibiotic dispensing events were 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 χ² tests were used to examine associations between dispensing source and selected non-antibiotic dispensing characteristics.
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 cephalosporins and other broad-spectrum agents used across several indications. 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.
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.
Background
Antimicrobial resistance (AMR) remains one of the leading global public health threats, directly responsible for an estimated 1.27 million deaths and associated with 4.95 million deaths globally in 2019, based on the most comprehensive analysis to date. The burden is highest in sub-Saharan Africa [1] The inappropriate use of antibiotics—particularly self-medication, incomplete courses, and dispensing without prescription—accelerates the emergence of resistant pathogens [2].
In Kenya, community pharmacies are a major source of antibiotics for both prescribed and non-prescribed use [3] These pharmacies represent a key interface between health systems and communities, often serving as the first point of care for common infections, particularly where access to formal healthcare is limited. While the Pharmacy and Poisons Act restricts antibiotic sales without prescription, enforcement remains inconsistent, particularly in peri-urban and rural settings. Evidence from Nairobi County indicates that 20–30% of antibiotic transactions occur without valid prescriptions [4], yet data from other counties are scarce. Limited surveillance outside major urban centres hampers local implementation of antimicrobial stewardship (AMS) interventions.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Eleanor Turnbull-Jones, Susannah Langtree, Nicholas Mogoi, Anthony Sifuna, Lindsay Gadaffi, Tony Jewell. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Drug use patterns at a Kenyan referral hospital: A cross-sectional study using WHO core indicators
- Evidence brief: Antibiotic prescribing and antimicrobial resistance: An evaluation of clinical teachers’ knowledge, attitude and practices at a South African dental school
- Evidence brief: Prevalence of antimicrobial resistance in Tanzania: A systematic review and meta-analysis
