Rising antibiotic resistance threatens UTI treatment in Malawi

A growing resistance to antibiotics is complicating the treatment of urinary tract infections (UTIs) in Malawi, with new research revealing that nearly half of women presenting with symptoms at a major referral hospital had infections resistant to multiple drugs.

The study, conducted by researchers at Mzuzu University and published in the National Library of Medicine, found a UTI prevalence of 48.5 per cent among women assessed at Malawi’s Zomba Central Hospital.

The data signals a public health concern that extends beyond expected physiological susceptibility in pregnancy.

It points toward broader social, behavioural, or systemic issues such as poor hygiene, limited access to healthcare, or the overuse of antibiotics without proper diagnostic testing.”

Pizga Kumwenda, study’s lead investigator and senior lecturer in microbiology and immunology at Mzuzu University

The figure, Kumwenda says, is far higher than the global and regional average of 14–30 per cent typically reported among pregnant women.

UTIs are among the most common infections in women globally, with an estimated 150 million cases occurring each year.

But in Malawi and other Sub-Saharan African countries, treatment is becoming increasingly difficult due to widespread antimicrobial resistance.

According to the study, first-line antibiotics such as ampicillin and ceftriaxone showed alarming resistance rates—87 per cent and 77 per cent respectively.

Particularly concerning was the emergence of multi-drug resistant strains such as Serratia marcescens, which exhibited complete resistance to several antibiotics and showed only moderate susceptibility to last-resort drugs like meropenem and amikacin.

“It showed 100 per cent resistance to several antibiotics,” said Kumwenda.

“Even drugs considered last-resort, such as meropenem and amikacin, showed only moderate effectiveness, which is a warning signal for future therapeutic difficulties,” he said.

Serious threat

Kumwenda says these findings reveal a serious threat to treatment outcomes, especially if even reserve antibiotics are becoming ineffective.

The retrospective study reviewed 340 patient records, focusing on women aged 15–45, who accounted for over half of the UTI cases.

The high burden in this reproductive-age group, coupled with elevated resistance rates, calls for more targeted diagnostic and treatment guidelines, the researchers say.

“We need to rethink how we manage UTIs in this demographic,” Kumwenda added.

“This includes incorporating hygiene and sexual health education, reviewing contraceptive use, and strengthening screening during antenatal and reproductive health visits.”

Malawi is already grappling with a broader AMR crisis.

The Malawi-Liverpool Wellcome Programme estimates that 27.3 deaths per 100,000 people in the region are attributable to antibiotic resistance. National data suggest up to 15,700 deaths in Malawi have been linked to drug-resistant infections.

The country has initiated surveillance efforts in human and animal health laboratories, but experts say more is needed.

Victor Mithi, president of the Society of Medical Doctors in Malawi, said self-prescription is a key driver of resistance in the country.

“Most patients in Malawi can just walk into a pharmacy and buy antibiotics without a prescription,” Mithi told SciDev.Net.

“As such, they are more likely to under-medicate themselves, resulting in the development of increasing antimicrobial resistance burden.”

He warned that untreated or poorly managed UTIs can escalate into life-threatening complications such as sepsis, particularly in young women.

To address this, Mithi says, there must be enforcement of prescription-only antibiotic sales.

“At the policy level, I think we need to strengthen the enforcement of people having a prescription before they go to any kind of pharmacy and procure prescriptive drugs,” he says.

A related study, published last year in BMC Infectious Diseases, also flagged the overuse of ‘watch’ antibiotics and a high rate of multi-drug resistant infections in northern Malawi.

Kumwenda and his team recommend the implementation of antibiotic stewardship programmes in health facilities.

“Health authorities should enforce strict prescription guidelines, promote culture and sensitivity testing before antibiotic initiation and prohibit over-the-counter sales of antibiotics without prescription,” he said.