Doctors forced back to the drawing board as E. coli gains resistance to popular anti-biotic

You may have or know someone who has struggled with a stubborn infection that keeps coming back.

If you have ever wondered why that infection did not clear as fast as expected, the answer may lie in how antibiotics were used.

New data from Nakuru's County Referral and Teaching Hospital (PGH) suggests that one of the most commonly used hospital antibiotics, Ceftriaxone, is losing its power against E. coli, a microorganism behind many of these infections- prompting doctors nationwide to rethink how they prescribe and use antibiotics.

This was revealed during a joint Antimicrobial Resistance (AMR) Symposium 2025 held at Kabarak University on December 9 themed ‘Act Now: Protect our present, secure our future’.

During the meeting several experts deliberated on the issues surrounding AMR (a situation where microorganisms like bacteria, viruses, fungi, and parasites no longer respond to drugs meant to kill them).

Dr Lydia Momanyi, a clinical pharmacist and the county antimicrobial stewardship focal person, explains that Ceftriaxone is an inpatient drug and falls under the Watch category of antibiotics.

“It's an injectable, so it's supposed to be used strictly in a hospital setting and is the most commonly used antibiotic among hospitalized patients at PGH. It falls under the Watch category AWaRe (Access, Watch, Reserve), a group of antibiotics the World Health Organization recommends for limited use due to their higher potential to cause resistance, WHO,” she says.

Being a Watch antibiotic means it should only be used after confirming an infection.

Ideally, a sample is taken to the lab, the organism causing the infection is grown, and then the antibiotic is tested against it. That's the proper sequence.

Dr Momanyi, however, notes that over time, this careful process was often bypassed, leading to misuse and overuse, and that they are now facing resistance.

“When we examined its effectiveness against E. coli, we found resistance levels of about 74 percent,” Dr Momanyi notes.

E. coli causes urinary tract infections (UTIs), bloodstream infections, meningitis, and pneumonia, all conditions that Ceftriaxone has historically been used to treat. But once data showed it was no longer effective, guidelines were revised nationwide.

“We are no longer using Ceftriaxone as much, both at PGH and countrywide,” she emphasizes.

“The guidelines released in December last year now prescribes Ceftriaxone only for meningitis, where effectiveness is still good. For all other infections, it is not recommended. It has essentially been given a timeout, and using lesser-used antibiotics surprisingly showed good susceptibility.” She said

Dr. Momanyi notes that they have also seen resistance in bacteria causing skin and soft tissue infections (methicillin-resistant Staphylococcus aureus- MRSA)

“MRSA causes wounds, boils, and post-surgical infections—particularly where hygiene is poor. These infections become hard to treat when organisms resist available antibiotics,” she notes.

And while a significant obstacle remains in diagnostics, since only PGH and Naivasha sub-county hospitals have diagnostic capacity in the county, doctors can't be certain what's happening in other facilities.

Despite this challenge, Nakuru County has made tremendous progress. Dr Momanyi notes that at PGH, the prevalence of antibiotic use has come down over time, dropping from 54.7 per cent in 2017 to 38.1 per cent as of October 2025.

“That's because clinicians now have the equipment and capacity to diagnose properly. The downward trend is a good thing because it also shows clinicians are becoming more cautious and practicing good antimicrobial stewardship.” Dr Momanyi says.