A rising resistance to antibiotics is complicating the therapy of urinary tract infections (UTIs) in Malawi, with new analysis revealing that almost half of girls presenting with signs at a serious referral hospital had infections immune to a number of medicine.
The study, carried out by researchers at Mzuzu University and printed in BMC Infectious Diseases, discovered a UTI prevalence of 48.5% amongst girls assessed at Malawi’s Zomba Central Hospital.
“The knowledge sign a public well being concern that extends past anticipated physiological susceptibility in being pregnant,” mentioned Pizga Kumwenda, the review’s lead investigator and a senior lecturer in microbiology and immunology at Mzuzu University.
“It factors towards broader social, behavioral, or systemic points similar to poor hygiene, restricted entry to well being care, or the overuse of antibiotics with out correct diagnostic testing.”
The determine, Kumwenda says, is way larger than the worldwide and regional common of 14%–30% sometimes reported amongst pregnant girls.
UTIs are among the many commonest infections in girls globally, with an estimated 150 million circumstances occurring annually.
But in Malawi and different Sub-Saharan African nations, therapy is turning into more and more troublesome resulting from widespread antimicrobial resistance.
According to the review, first-line antibiotics similar to ampicillin and ceftriaxone confirmed alarming resistance charges—87% and 77% respectively.
Particularly regarding was the emergence of multi-drug resistant strains similar to Serratia marcescens, which exhibited full resistance to a number of antibiotics and confirmed solely reasonable susceptibility to last-resort medicine like meropenem and amikacin.
“It confirmed 100% resistance to a number of antibiotics,” mentioned Kumwenda.
“Even medicine thought-about as a last-resort, similar to meropenem and amikacin, confirmed solely reasonable effectiveness, which is a warning sign for future therapeutic difficulties,” he mentioned.
Serious risk
Kumwenda says these findings reveal a critical risk to therapy outcomes, particularly if even reserve antibiotics have gotten ineffective.
The retrospective study reviewed 340 affected person information, specializing in girls aged 15–45, who accounted for over half of the UTI circumstances.
The excessive burden on this reproductive-age group, coupled with elevated resistance charges, requires extra focused diagnostic and therapy pointers, the researchers say.
“We have to rethink how we handle UTIs on this demographic,” Kumwenda added.
“This consists of incorporating hygiene and sexual well being training, reviewing contraceptive use, and strengthening screening throughout antenatal and reproductive well being visits.”
Malawi is already grappling with a broader AMR disaster.
The Malawi-Liverpool Wellcome Program estimates that 27.3 deaths per 100,000 individuals within the area are attributable to antibiotic resistance. National knowledge recommend as much as 15,700 deaths in Malawi have been linked to drug-resistant infections.
The nation has initiated surveillance efforts in human and animal well being laboratories, however specialists say extra is required.
Victor Mithi, president of the Society of Medical Doctors in Malawi, mentioned self-prescription is a key driver of resistance within the nation.
“Most sufferers in Malawi can simply stroll right into a pharmacy and purchase antibiotics with out a prescription,” Mithi informed SciDev.Net.
“As such, they’re extra more likely to under-medicate themselves, ensuing within the growth of an growing antimicrobial resistance burden.”
He warned that untreated or poorly managed UTIs can escalate into life-threatening problems similar to sepsis, notably in younger girls.
To deal with this, Mithi says, there have to be enforcement of prescription-only antibiotic gross sales.
“At the coverage stage, I believe we have to strengthen the enforcement of individuals having a prescription earlier than they go to any sort of pharmacy and procure prescriptive medicine,” he says.
A associated study, printed final yr in BMC Infectious Diseases, additionally flagged the overuse of ‘watch’ antibiotics and a excessive fee of multi-drug resistant infections in northern Malawi.
Kumwenda and his group advocate the implementation of antibiotic stewardship packages in well being services.
“Health authorities ought to implement strict prescription pointers, promote tradition and sensitivity testing earlier than antibiotic initiation and prohibit over-the-counter gross sales of antibiotics with out prescription,” he mentioned.
More info:
Pizga Kumwenda et al, Characterization of urinary tract infections amongst females at a tertiary hospital in Malawi: a retrospective study, BMC Infectious Diseases (2025). DOI: 10.1186/s12879-025-10842-5
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