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Combating antibiotic resistance using guidelines and enhanced stewardship in Kenya: a protocol for an implementation science approach
  1. Jesse Gitaka1,
  2. Moses Kamita1,
  3. Dominic Mureithi2,
  4. Davies Ndegwa3,
  5. Moses Masika4,
  6. Geoffrey Omuse5,
  7. Moses Ngari6,
  8. Francis Makokha1,
  9. Peter Mwaura1,
  10. Ronald Mathai1,
  11. Francis Muregi1,
  12. Matilu Mwau7
  1. 1Research and Innovation, Mount Kenya University, Thika, Kenya
  2. 2Department of Animal Health and Production, Maasai Mara University, Narok, Kenya
  3. 3Department of Medical Laboratory Sciences, Kenya Medical Training College, Nairobi, Kenya
  4. 4Department of Medical Microbiology, University of Nairobi College of Health Sciences, Nairobi, Kenya
  5. 5Department of Pathology, Aga Khan University, Nairobi, Kenya
  6. 6Clinical Trial Facility, KEMRI/Wellcome Trust, Kilifi, Kenya
  7. 7Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Nairobi, Kenya
  1. Correspondence to Dr Jesse Gitaka; jgitaka{at}


Introduction Antimicrobial resistance (AMR) is a growing problem globally especially in Sub-Saharan Africa including Kenya. Without any intervention, lower/middle-income countries (LMICs) will be most affected due to already higher AMR levels compared with higher income countries and due to the far higher burden of diseases in the LMICs. Studies have consistently shown that inappropriate use of antimicrobials is the major driver of AMR. To address this challenge, hospitals are now implementing antibiotic stewardship programmes (ASPs), which have been shown to achieve reduced antibiotic usage, to decrease the prevalence of resistance and lead to significant economic benefits. However, the implementation of the guideline is highly dependent on the settings in which they are rolled out. This study, employing an implementation science approach, aims to address the knowledge gap in this area and provide critical data as well as practical experiences when using antibiotic guidelines and stewardship programmes in the public health sector. This will provide evidence of ASP performance and potentially contribute to the county, national and regional policies on antibiotics use.

Methods and analysis The study will be conducted in three geographically diverse regions, each represented by two hospitals. A baseline study on antibiotic usage, resistance and de-escalation, duration of hospital stay, rates of readmission and costs will be carried out in the preimplementation phase. The intervention, that is, the use of antibiotic guidelines and ASPs will be instituted for 18 months using a stepwise implementation strategy that will facilitate learning and continuous improvement of stewardship activities and updating of guidelines to reflect the evolving antibiotic needs.

Ethics and dissemination Approvals to carry out the study have been obtained from the National Commission for Science, Technology and Innovation and the Mount Kenya University Ethics Review Committee. The approvals from the two institutions were used to obtain permission to conduct the study at each of the participating hospitals. Study findings will be presented to policy stakeholders and published in peer-reviewed scientific journals. It is anticipated that the findings will inform the appropriate antibiotic use guidelines within our local context.

  • antimicrobial stewardship
  • antimicrobial resistance
  • implementation science

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  • Contributors JG initiated the concepts of the study. JG, DM, DN, MMasika, GO, MN, FMakokha, PM, RM, FMuregi and MMwau developed the protocol. JG, DM, DN and MMasika will be involved in training the ASCs. DM, GO, MN, FMakokha, PM, RM, DN and MK will help in data collection. MN and MK will be involved in data analysis. MK wrote the first draft of the manuscript. All authors reviewed and approved the protocol.

  • Funding This work was supported by The Kenya National Research Fund (grant number NRF/MKU/2017/007 to JG).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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