Cross-sectional study finds high antibiotic use for productive cough in Kenyan clinic patients

Introduction: Antibiotic misuse is a major driver of antimicrobial resistance (AMR), contributing to an estimated 1.27 million deaths globally. In Kenya, inappropriate antibiotic use is shaped by health-seeking behaviors and sociodemographic factors. However, little is known about how adults with productive coughs seek and use antibiotics, or how sociodemographic factors underpin these practices. This study explored antibiotic-seeking pathways, usage patterns, and the sociodemographic factors influencing these practices among adults with productive coughs attending selected chest and tuberculosis clinics in Nairobi County, Kenya. Methodology: A facility-based cross-sectional study was conducted among 400 adults ([≥]18 years) with productive coughs. Data were collected using a structured questionnaire on sociodemographic characteristics, antibiotic-seeking pathways, and use patterns. Results: Most participants were male (65.0%) and employed (67.0%), with 68.3% earning below Ksh 10,000 (approximately USD 80) monthly and 35.8% having basic education. A history of smoking (37.3%), tuberculosis (32.0%), or other comorbidities (29.8%) was common. Among 347 (86.7%) antibiotic users, 46.4% obtained antibiotics through general practitioners (GP) only, 31.4% via both GP and over-the-counter (OTC) sources, 15.3% from OTC only, and 6.9% through self-medication. Females were more likely to self-medicate (13.3% vs. 3.2%) and had higher odds of antibiotic use (cOR: 2.00; 95% CI: 1.04-4.10). Tuberculosis history was linked to greater GP reliance (61.7% vs. 37.4%). Low-income participants mainly used GP-only sources, while higher-income earners favored GP plus OTC routes (RRR: 2.67; 95% CI: 1.41-5.05). Empirical use was common (71.1%), dominated by Amoxicillin (90.8%), with multiple antibiotic use reported by 67.2% of the participants. Conclusion: Antibiotic use among adults with productive coughs in Nairobi was widespread and largely empirical, dominated by Amoxicillin and Amoxicillin/Clavulanic acid. Self-medication, unregulated antibiotic access, and inappropriate use highlight the urgent need for stricter prescription enforcement and strengthened stewardship programs to promote rational antibiotic use and curb AMR.