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Using treatment guidelines to improve antibiotic use: insights from an antibiotic point prevalence survey in Kenya
  1. Michuki Maina1,2,
  2. Jacob McKnight3,
  3. Olga Tosas-Auguet3,
  4. Constance Schultsz2,4,
  5. Mike English1,3
  1. 1Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Nairobi, Kenya
  2. 2Amsterdam UMC, Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
  3. 3Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
  4. 4Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
  1. Correspondence to Dr Michuki Maina; MMaina{at}

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Summary box

  • Clinical practice guidelines have the potential to improve quality of care through improving decision making and antibiotic prescription. These guidelines are particularly important in areas with limited laboratory and specialist capacity.

  • For some of the common conditions managed in the hospitals, guidelines are not available or are outdated.

  • To reduce irrational antibiotic use and contain the threat of antimicrobial resistance, the process of guideline development should prioritise the most common diseases.

  • The process of developing context-appropriate clinical guidelines requires input from all relevant stakeholders with leadership from the Ministry of Health. This process needs to have a clear plan for dissemination, training and future updates.


Antimicrobial resistance (AMR) is a significant public health threat that is expected to worsen as more drug-resistant organisms emerge.1 This situation is further exacerbated by the low rate of discovery of new antimicrobial agents that could act against drug-resistant micro-organisms. AMR could retard economic growth in low-income countries and delay attainment of the sustainable development goals.2

There are multiple drivers of AMR, but one of the key drivers has been the irrational use of antimicrobial agents.3 In hospitals, lack of timely and accurate diagnostic tests, including microbiology for bacterial speciation and drug susceptibility testing, leads to unnecessary antimicrobial use, fueling resistance and healthcare costs.4 While countries must work to improve diagnostic capabilities and increase laboratory capacity to enhance diagnostic accuracy, it is also important to complement this new capacity with locally relevant guidelines. Providing context-specific, applicable and regularly updated treatment guidelines to front-line doctors is an effective means to improve antibiotic usage and clinical care.5

Clinical practice guidelines (CPG) provide a standardised and systematic approach to responding to disease, including the treatment. The guidelines are, however, more effective in the context of a functioning health system with adequate clinicians, drugs, …

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