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The Ministry of Health is expanding cooperation with international partners in the fight against antimicrobial resistance

4 December 2023
51

Controlling, detecting and monitoring the spread of infectious diseases and antimicrobial resistance is one of the key topics discussed by the Ministry of Health of Ukraine at the international conference in Stockholm “Promoting the Revival and Development of Healthcare in Ukraine”.

Bacterial resistance to antibiotics occurs due to their overuse, improper prescription, and non-compliance with the treatment course. Bacteria change under the influence of drugs, so antibiotics stop working, and infectious diseases cannot be treated.

Antibiotic resistance threatens the effective prevention and treatment of any infection anywhere in the world. In 2015, the WHO launched a global surveillance system for antimicrobial resistance and use. Ukraine joined it a few years ago and is actively implementing the changes necessary to confront the problem. Over the past 4 years, the number of bacteriological laboratories has increased from 37 to 69, and sentinel surveillance of antimicrobial resistance has been strengthened.

“In every hospital, regardless of ownership, infection control departments have been set up to ensure surveillance of infectious diseases associated with the provision of medical care and administration of antimicrobials. Since 2022, an electronic prescription has been in place, and national standards have been introduced to regulate the use of antibiotics in the pre-hospital stage and during inpatient treatment. Since the beginning of the full-scale war, the problem of antimicrobial resistance has become more acute due to the increase in the number of wounded.  In addition, a significant number of antibacterial drugs are supplied with humanitarian aid, and control over their use is quite limited. In order to mitigate the risks associated with the war and to fulfill the strategic goals set by the WHO and the European Union, the Ministry of Health has developed a new National Action Plan to combat antimicrobial resistance, which will include expanding the national network of microbiological laboratories, strengthening the infection control system at the level of health care facilities, and surveillance of resistant pathogens, taking into account the intersectoral approach of the “One Health”, said Deputy Minister of Health, Chief State Sanitary Doctor of Ukraine Ihor Kuzin.

According to the WHO, in 2019, nearly 5 million deaths worldwide were attributed to antibiotic resistance, including more than a million directly caused by it. As bacteria gradually develop resistance to antibiotics, treatment for infectious diseases of bacterial origin, such as pneumonia, tonsillitis, tuberculosis, and gonorrhea, is becoming more difficult every year. Surgical operations, such as cesarean sections or appendectomies, organ transplants, and chemotherapy are becoming more and more risky.

Antimicrobial resistance is especially dangerous in times of war, so the Ministry of Health approved a single standard based on research and approaches to the prophylactic use of antibiotics, which allows for high-quality treatment of the wounded. Some victims and the military have infectious complications caused by pathogens that are insensitive to these drugs in more than 75%, and in some cases - up to 100%. However, the nosologies (pathogens) that are treated mainly with these drugs have not disappeared. Therefore, the standard “Rational Use of Antibacterial and Antifungal Drugs for Therapeutic and Prophylactic Purposes” was amended: ceftriaxone and levofloxacin were transferred to the reserve group antibiotics (according to the WHO AWaRe classification). The innovation prohibits the use of these drugs as first choice, and even more so for prophylactic purposes when the pathogen has not been identified. First, a doctor must provide a written justification and approval from a clinical pharmacist before prescribing these antibiotics.

The standard also updates approaches to the principle of antibiotic selection based on the results of bacteriological testing. Now, doctors and clinical pharmacists can more quickly determine which drug to choose if the pathogen is sensitive to several antibiotics: an antibiotic with a lower risk of AMR is prescribed according to the assignment to a certain WHO AWaRe group (in the absence of direct contraindications).

The introduction of an electronic prescription for antibiotics in August 2022 was a major step towards solving the problem of uncontrolled dispensing and irrational use of antibiotics. Since then, 933 thousand electronic prescriptions for antibiotics have been issued. An e-prescription can be obtained from any doctor, regardless of the presence of a declaration with a family doctor.

The training activities (trainings, webinars, seminars) in the areas of infection prevention, infection control and counteraction to the spread of antimicrobial-resistant pathogens are continuing to be conducted.

It should be recalled that the Ministry of Health approved a new standard of medical care “Rational use of antibacterial and antifungal drugs for therapeutic and prophylactic purposes” by Order No. 1513 dated 23.08.2023. It is developed following the best international medical practices and defines which antimicrobials, in which cases and by what mechanisms should be prescribed by doctors to patients to achieve high-quality and safe treatment with minimal risks of spreading antimicrobial resistance.

According to the Order of the Ministry of Health of Ukraine No. 1614 dated 03.08.2021, a system of infection prevention, infection control and administration of antimicrobial drugs must be introduced in every hospital, regardless of ownership. The set of measures envisaged by this order will improve the fight against the spread of infectious diseases associated with the provision of medical care, strengthen their prevention, reduce the spread of antimicrobial resistance, optimize the use of antibiotics and reduce the financial burden on the hospital.