Problem of antibiotic resistance in Bukovina and ways to overcome it.

There are many pharmacies in Ukraine in general and in Bukovina in particular. Until August 1, 2022, there were no state restrictions on the sale of any antibiotics by commercial pharmacies in Ukraine. This led to the uncontrolled use of antibiotics and, accordingly, persistent antimicrobial resistance.

Vasyl Moskaliuk, MD, Professor, Chief of the department of infectious diseases and epidemiology, Bukovinian State Medical University

Antibiotic resistance (antimicrobial resistance) and the emergence of multidrug-resistant bacterial strains is a problem of global importance that poses serious threats to humanity. Antibiotic resistance is a natural phenomenon, but inappropriate, uncontrolled and irrational use accelerates this process, resulting in longer hospital stays, increased medical costs and deaths (World Health Organization (WHO), 2020).

If in the world in general a lot of attention is paid to this problem, then at the regional level (in Bukovina in particular) this issue has not been studied enough and to date there is no generalized information about the real reasons for the development of antibiotic resistance in patients who receive medical care in health care institutions of Bukovina at all levels, and the relationships between the causes and possibilities of solving this problem in this region have not been established. As a result, in practice, we see a rapid increase in the insensitivity of the most common microorganisms to antibiotics. And those antibacterial drugs, which, for example, were widely used a year ago, are ineffective today and the patient remains alone with the disease and doctors cannot help him.

Our decision is aimed at reducing antibiotic resistance in Bukovyna. The conclusions of our research will be implemented both in health care institutions at all levels and among ordinary citizens.

We aim to cover such needs as:

• reduction of antibiotic resistance in this region;

• reducing the development of resistance of microorganisms to antibacterial drugs;

• research of the most common bacteria registered in this region and study of their sensitivity to antibacterial drugs;

• increasing public awareness of this problem.

WHO predicts a significant increase in the mortality rate from diseases caused by polyresistant microflora in the near future. That is why this organization has developed a Global Action Plan, which aims at five strategic objectives and whose ultimate goal is to eliminate the main causes of antibiotic resistance. Our research will be aimed at identifying gaps in the knowledge of the population of the Chernivtsi region regarding antibiotic resistance, identifying and analyzing the main reasons for over-the-counter use of antimicrobial drugs, and therefore, based on the obtained data, it will be possible to form and distribute thematic materials through mass media and social networks. Also, our research will aim to fulfill another strategic task from the WHO Global Action Plan - to strengthen the supervision and analysis of the "culture" of prescribing antimicrobial drugs by doctors of various units of the regional multidisciplinary clinic (Chernivtsi Regional Clinical Hospital). Respectively, specialists of the Department of Infectious Diseases and Epidemiology, having the results of such an analysis, will be able to participate in educational activities for hospital staff, and will also be able to develop new thematic improvement courses for general practitioners - family medicine.

The decision will allow all people of our region (Chernivtsi, Ukraine) to be convinced of the looming global danger of antibiotic resistance, the formation of cause-and-effect relationships of antibiotic resistance addiction and a mindless approach of buying, taking antibiotics that are offered in pharmacies on counters and advertised on regional and Ukrainian television. It will allow doctors to increase their responsibility regarding off-label antibiotic prescribing and educational work among their patients, using the authority of their position. The role of the doctor's authority at all stages of decision-making regarding the purchase of an antibiotic and the nature of its use (doses, frequency, etc.) was proven in earlier studies of the Center for Public Health.

It will be necessary to develop a plan for prompt delivery of reliable and comprehensible information about antibiotics, development risks and ways to combat antibiotic resistance. It is planned to create information channels in Telegram, an electronic information booklet for distribution in popular social networks.

Continue in the monitoring mode research among doctors on the cases in which they prescribe antibiotics, in order to exclude the problem of excessive prescription of antimicrobial drugs (or monitor the dynamics).

Monitoring will mainly relate to antibiotic therapy administered to patients in the regional hospital's infectious disease unit, namely the effectiveness of conventional antibiotic regimens and the reasons for ineffectiveness and the need for substitution. A quantitative study of the problem of antibiotic resistance at the regional level will be conducted to identify people's awareness of this threat. The opening of a new infection control unit in each hospital of the region, in particular the Chernivtsi Regional Clinical Hospital, allows us to think about the right vector to combat the problem of antibiotic resistance at the level of various units of multidisciplinary hospitals.

Since it is proposed to use a questionnaire in the form of a Google form for the convenience of conducting the study, this may create obstacles when collecting data among older patients. The survey data of this population cohort should not be overlooked, because the elderly are a risk group for many infectious diseases, and as a result the candidates for frequent prescription of antibiotics. Therefore, it is worth investigating the awareness of this group of people about the problems of resistance to antimicrobial drugs. For that reason, it is suggested to use the usual printed version of this questionnaire. It is also important to inform this cohort through traditional communication channels, such as television and radio, about the health risks of self-medication with antimicrobial agents or premature termination of the course of therapy after improvement of the general condition.

The problem of antibiotic resistance existed in Ukraine even in the pre-pandemic years. During the pandemic, it became larger, which we, practical infectious disease doctors, felt in our daily practice treating patients with various infectious diseases. Effective antibiotic therapy regimens have stopped working, which forces the use of reserve drugs. The burden of war only worsens the situation to work in this direction and only magnifies the problem. The possibility of cooperation with Trinity Challenge will provide an opportunity to use the support for a more detailed study of the practical aspects of uncontrolled antibiotic prescribing and to identify possible points of prevention and control of the problem of antibiotic resistance in the doctor-patient aspect.

The organization that began to work actively in this direction is the Center of Public Health (Ukraine). The direction of our team's work will significantly affect the more specific identification of the problem of antibiotic resistance in our individual region and will allow us to influence the causes identified in our region. The Public Health Center of Ukraine, having some experience of studying these issues in Ukraine in general, will be able to significantly support the regional project in solving the tasks.

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