Background: In low- and- middle income countries, symptomatic urinary tract infection (UTI) patients are often prescribed antibiotics without microbiological confirmation. UTIs caused by antibiotic resistant bacteria are increasingly common and this heightens the risk of empirical treatment failure. This study evaluates the appropriateness of empirical antibiotic therapy to symptomatic UTI patients. Methods: A hospital-based, cross-sectional study was conducted in Nairobi County, Kenya among symptomatic adult and child patients. UTI was defined as a monoculture growth with colony counts of ≥104. cfu/ml. Antimicrobial susceptibility testing (AST) was performed by the Kirby-Bauer disc diffusion method. Empirical therapy was considered appropriate if the pathogen isolated was susceptible to the prescribed antibiotic and inappropriate if pathogen was resistant to prescribed antibiotic. Results: A total of 552 participants were enrolled with a median age of 29 years (IQR:24-36). The majority were female; 398 (72%). Of the 552, 274 (50%) received empirical antibiotic therapy, 95/274 (35%) were confirmed to have UTI by culture. The antibiotics most frequently prescribed were fluoroquinolones [ciprofloxacin in 80 (30%) and levofloxacin 43 (16%)], amoxicillin-clavulanic-acid in 48 (18%), and nitrofurantoin in 32 (12%). Amongst the 95 patients with bacteriological confirmation of UTI, 50 (53%) received appropriate empirical antibiotic therapy, whilst for 38 (40%) participants, the therapy was inappropriate. Appropriateness of empirical therapy to 7 (7%) patients could not be determined as the antibiotics prescribed were not in the AST panel. Conclusion: The complexity of appropriate empirical treatment for UTIs is compounded by high levels of resistance in UTI pathogens. AMR surveillance strategies that could help in designing appropriate empirical regimens in resource constrained settings should be adopted for optimal empiric therapy.

The authors have declared no competing interest.

This study was funded by the Global challenges research fund (GCRF)

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This study received approval from University of St. Andrews Teaching and Research Ethics Committee, United Kingdom [Approval no. MD15749]; Jomo Kenyatta University of Agriculture and Technology Institutional Ethics Review Board, Kenya [Approval no. JKU/IERC/02316/0166], National Commission for Science Technology and Innovation, Kenya [Approval no. P/21/12520]. Nairobi Metropolitan services, MLKH and MDH provided approvals for access to the study sites. Informed consent was obtained from each participant included in the study.

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