AMR: Harbinger of Global Health Disaster

Inside Kenya’s Fight Against Antibiotic-Resistant Infections — and the Surprising Allies Helping Us Fight Back

BY ZAHRA SOBA – A Freelance Health Journalist

When a chronic diabetic foot ulcer threatened to take away a patient’s limb in 2013, nurses at Kenyatta National Hospital turned to a rather unexpected age-old practice: maggot therapy. Almost immediately, the live larvae began eating away the necrotic, infected tissue, leaving behind healthy flesh that could finally regenerate and heal. This was the first time maggot therapy had been used on a patient in Kenya, and these “micro-surgeons” not only saved a limb but also spared the patient from hefty medical bills by speeding up recovery and shortening hospital stay.

This is just one of the many unconventional — and perhaps unsettling — approaches being explored as rates of antimicrobial resistance (AMR) continue to rise.

But hold on, antimicro- what now? The word is a mouthful, and that’s probably why you haven’t heard much about it. There’s simply too much scientific jargon for anyone outside the medical field to pay attention. Yet hidden within it lies a crisis that threatens everything from childbirth to urinary tract infections to routine surgical procedures.

To put it simply, antibiotic-resistant infections — what scientists call antimicrobial resistance (AMR) — occur when microbes such as bacteria, fungi, and viruses evolve to resist the effects of drugs designed to destroy them. More than just surviving, they multiply and thrive in the presence of our strongest medicines, forcing doctors Erika Hayden to cycle through multiple antibiotics before finding one that works — if the patient is lucky — rendering these once-prized discoveries of the 20th century increasingly useless.

“The term antimicrobial resistance is difficult, long, and confusing. Most people don’t know what a microbe is or whether resistance is a good or bad thing,” says Erika Hayden, Director of Science Communication at the University of California, Santa Cruz. “And then there’s the question of who is resistant — us or the microbes? Those who’ve heard about it see it as a problem of the future, and they already have enough to worry about today. Why should they be concerned about a threat that feels distant or uncertain? This is what we need to answer.”

No facet of health is untouched by this problem — which is why the accidental discovery of penicillin, the first antibiotic, was nothing short of revolutionary. Before antibiotics, people didn’t die of cancer, diabetes, or heart disease; they died from infections we now deem mere inconveniences — pneumonia, cholera, tuberculosis, and even infected wounds. The discovery of penicillin was so profound that it is credited with boosting average life expectancy from 45 to nearly 80 years.

Are we now on the verge of completely undoing a century’s worth of medical progress? Not if we can help it.

Half Human, Mostly Microbe

We think of ourselves as human, but biologically speaking, that’s only half the story. Beneath and on our skin thrive ecosystems of trillions upon trillions of microbes that vastly outnumber our human cells. In the human gut alone, microbial cells outnumber human ones by 10 to 1 — totalling roughly 100 trillion microbes weighing about 2 kilograms — not to mention the many others on our skin, in our mouths, and elsewhere.

These microbes — bacteria like E. coli, viruses such as those that cause COVID-19 or influenza, and fungi that cause athlete’s foot — play active roles in maintaining the delicate balance between health and disease. From our oral cavities to the folds of our skin, to the depths of our gut, lungs, and reproductive system, they work constantly to strengthen our immune system, digest food, protect against pathogens, and even produce essential nutrients.

However, when this balance is disrupted, these peacefully coexisting microbes can turn against us, causing endogenous infections, while external invaders such as COVID-19 exploit weakened defences.

It is these infections — whether homegrown or foreign — that antibiotics were developed to treat. But repeated misuse and overuse, both in the human and animal sectors, have given microbes the upper hand time and again, allowing them to “study” our strongest drugs and develop defences against them.

Microbes, much like humans, are hardwired to survive. Faced with threats such as antibiotics, they change their genetic makeup and acquire survival traits from other microbes — essentially sharing blueprints on how to outsmart our most potent drugs. And they do this astonishingly fast. While humans take about 30 years to produce a new generation, bacteria such as E. coli can double in as little as 20 minutes. Each round of replication gives them countless opportunities to mutate and pass on the versions that survive.

A Pill for Every Ill

Of all the things we overuse unquestioningly, antibiotics must be at the top of the list.

Stocked in pharmacies, casually handed out, and swallowed at the slightest hint of discomfort, they have quite literally become the “just in case” medications we reach for to ward off a suspected cold or stomach-ache — often without taking the time to investigate symptoms or, better yet, allow our bodies to fight off infection naturally. This behaviour is largely a result of how our healthcare system operates. Doctors are often guilty of carelessly or unnecessarily prescribing antibiotics — sometimes at the patient’s request, sometimes due to slow diagnostic tools, and often because of pressure from pharmaceutical companies that offer incentives for prescribing their drugs.

“One of the most commonly misused   antibiotics is Azithromycin, for instance, is affordable and widely used to treat colds and stomach upsets,” says Davis Mkoji, Deputy Director of Corporate Communications at the Kenya Medical Research Institute (KEMRI). “But every time you take an antibiotic, unnecessarily and without properly following doctors prescription, you are not just creating a problem for yourself — But you are exposing everyone else to resistance. Just like in smoking, the harm extends beyond the smoker to those who breathe in the fumes.” The greatest offender, however, may not be humans but agriculture.

In the U.S., agriculture consumes about 34 million pounds of antibiotics each year, compared to 7.7 million pounds used in human medicine. Kenya is no different, with the majority of antibiotics used for growth promotion — particularly in poultry — and to prevent disease in crowded, unsanitary, and stressful farm conditions. Farmers are known to add low doses of antibiotics to animal feed throughout the year, creating the perfect Davis Mkoji animals but in humans too.

As we consume eggs, meat, dairy products, and even plant-based foods like fruits and vegetables laced with antibiotic residues, we give microbes countless opportunities to adapt and develop resistance. But it doesn’t end there. Residues of antibiotics and resistant microbes from households, farms, and hospitals flow into our soil, water, and food systems — creating a continuous cycle of exposure and resistance. What began as misuse in one sector has now become a shared, multisectoral crisis.

The complexity of antibiotic-resistant infections is why Kenya’s National Action Plan on Antimicrobial Resistance adopted the One Health approach, recognizing the interconnectedness of human, animal, and environmental health. But awareness alone can only go so far. Much more needs to be done collectively to remain one step ahead of these microbes. Which begs the question: why isn’t this topic in public and media consciousness? Perhaps communication failures extend well beyond marriage and relationships.

The Message That Never Landed

“We talk about antimicrobial resistance (AMR) in boardrooms and conferences, but rarely do we show what it means for people’s everyday lives — their health, livelihoods, and families,” says Dr. Mercy Korir, CEO and Editor-in-Chief of Willow Health Media. She notes that much of the problem lies in weak regulation.

“Nearly 75 percent of AMR stems from regulatory gaps. Antifungals, antibiotics, and other antimicrobials should be prescription-only medicines. It’s up to the Pharmacy and Poisons Board to ensure that only licensed pharmacies dispense them and that unregistered outlets are shut down. Enforcement must be consistent across the board; we cannot depend on consumers’ goodwill.” For her, community engagement is key. “We need to go back to the basics — barazas, school meetings, and under-the-tree conversations. We forget that these are powerful spaces for shaping understanding and influencing decisions at the household level.”

These sentiments are echoed by Mr. Mkoji, who emphasizes the importance of not treating antibiotic-resistant infections as a siloed issue. “At KEMRI, we integrate AMR into everything we do — whether it’s malaria, TB, HIV, or other diseases. If we fail to look at it holistically, we lose,” he says. For Mkoji and his team, the solution lies in communication and public engagement. He recalls first learning about AMR in 2016, when KEMRI’s communications team began brainstorming how to make the issue relatable. “We spent a lot of time figuring out how to simplify it because people weren’t seeing the urgency,” he says. “But the rise of cases like super gonorrhoea in 2023 shows this isn’t a problem of the future — it’s a problem now.”

Maggots and Sewage to the Rescue

Science has a way of finding solutions in the most unlikely places — take sewage and maggots, for example. Hardly the heroes you’d expect, and yet both are pivotal in our fight against antibiotic-resistant infections.

“In principle, maggot debridement therapy uses sterile larvae of the green bottle fly to eat away dead, necrotizing tissue,” says Paul Muriuki, a research scientist at the Kenya Agricultural and Livestock Research Organization (KALRO) based at the Biotechnology Research Institute. “When applied to a wound, the larvae feed exclusively on dead tissue, leaving healthy flesh untouched. They can be placed directly on a wound (free-range), where they’re able to move freely into every crevice and eat away 100% of the dead tissue. Alternatively, they can be enclosed in a biosac, releasing secretions that dissolve dead tissue before sucking up the liquified material. Either way, their precision makes them invaluable against antibiotic-resistant bacteria like Methicillin-Resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, which form biofilms that even the strongest drugs can’t penetrate.”

Their work doesn’t end there. The maggots’ secretions and excretions form a protective barrier, while their mechanical action stimulates blood flow to the site, fostering cell regeneration.

One round of therapy costs about KShs. 10,000 (KShs. 4,000 per maggot dose plus dressing costs of about KShs. 6,000), compared to KShs. 50,000–200,000 for surgical debridement. It doesn’t require antibiotics before or after treatment, making it ideal for patients too weak for surgery.

Yet uptake remains extremely low, with only a handful of medics trained in 2013 still practicing the method. Those who do, however, report success rates of up to 98%.

“Even the best surgeon is only able to remove up to 60% of dead tissue,” says Muriuki. “Our microsurgeons achieve 100%.” While maggots clean wounds on the surface, bacteriophages — or simply phages — work at the microscopic level, infecting and destroying bacteria from within. Naturally abundant in soil, oceans, and yes, sewage, phage’s are emerging as one of the most promising tools against antibiotic-resistant infections.

That is Ely Aboka, microbiologist why a and founder of the Phage Hunters Training and Research Program in Kenya, decided to create his own mentorship initiative to advance phage research and reduce antibiotic misuse in livestock production.

 Through local workshops, he trains students on the potential of phages — viruses that infect and kill bacteria — as natural alternatives to antibiotics. But progress, he says, has been painfully slow.

“Senior scientists leading phage research are not willing to share their discoveries,” he says. “We haven’t really moved forward in Africa when it comes to phages; the furthest we’ve gone is animal models. Five years on, the plan to set up a national phage bank hasn’t materialized.” Aboka points to a culture of fragmentation.

“Those at the forefront of phage research haven’t done enough to bring the right stakeholders together so that phages reach those who need them most. There’s a huge knowledge gap between us and the West, and without collaboration, we can’t close it.”

For Aboka, the most practical starting point is livestock. “This is where we have the most unregulated use of antibiotics,” he says. “If we can introduce phage use in livestock and reduce antibiotic misuse there, we’ll have already won half the war against AMR.” There remain, however, significant financial, regulatory, and awareness hurdles before these innovations can be mainstreamed.

A Dose of Responsibility

You may have taken an antibiotic for a cold and felt better soon after — but don’t be too quick to credit the pills. Colds are caused by viruses that antibiotics can’t eliminate. So why the relief? In most cases, your immune system was already winning the fight, and the timing of the medication was coincidental. Or you might have had a secondary bacterial infection that the antibiotic treated. Either way, here’s how to keep antibiotics working — for you and for generations to come:

1. Wash, rinse, repeat (literally) Handwashing remains the simplest and most effective form of infection prevention and control. Clean hands mean fewer germs — and fewer excuses to reach for antibiotics.
2. Roll up your sleeve Ensure you’re up to date with vaccinations. Prevention is always better than cure.
3. Skip the guesswork Not every sniffle or ache needs a prescription. Get a proper diagnosis before accepting antibiotics
4. Finish what you start Not completing your antibiotics as prescribed is the perfect way to breed resistance. See them through to the end — even if you already feel better.
5. Handle food like it matters — because it does Safe food preparation and storage prevent infections that might require antibiotic treatment.
6. Question everything (especially your doctor’s judgment) Don’t passively accept what’s prescribed. Make sure you’re using the right drug for the right reason.