Optimization of Antibiotic Therapy and Monitoring of Antibiotic Resistance in the Karaganda Region of Kazakhstan

1. Optimization of Antibiotic Therapy and Monitoring of Antibiotic Resistance in the Karaganda Region of Kazakhstan Karaganda

2. Kazakhstan population is 15000000 peopleKaraganda region population is 1.5 milKaraganda region 428 thousand sq. km.

3. IntroductionAntibiotics - is a expensive group of drugs

4. Quantity of expenditure antibiotics of whole drugs

5. Percentage of injection form of antibiotics

6. Long-term resistance dynamics of E.coli to ciprofloxacin. This slide doesn`t reflect real picture of antibiotic resistance level

7. Introduction: Antibiotic use in Karaganda is without proper control: • Absence drug monitoring system (only two hospital have bacteriology labs) • Absence of infection control and program of the fight with hospital infection • Absence clinical protocol (treatment standards) of antibiotic prophylaxis and antibiotic therapy • Formulary system in hospital just begin to inculcate (Initiator of formulary system inculcation in Karaganda region became drug information center) The main criteria during antibiotic purchase is price, but not quality. Doesn't determine biological availability and biological equivalence of drugs during purchase.

8. The main goal • Antibiotic use status description in primary health departments and hospitals and search the ways of antibiotic use optimization • To conduct antibiotic use research in primary health departments patients with acute respiratory disease (ARD) and acute bronchitis • To conduct antibiotic use research in surgical hospital • To perform study programs • To perform clinical approbation of antibiotic prophylaxis standard Tasks of research

9. Materials and methods Research retrospective, randomized, cases in outpatient and hospital departments were analyzed The first antibiotic use research patients with acute bronchitis and ARD, cases in outpatient and hospital departments were analyzed 20 outpatient case histories of adult patients and in every of 63 primary health departments (PHD), (45 PHD in Karaganda, 10 PHD in Zhezkazgan, 8 PHD in Satpaev) were chosen by means of randomized collection in 4 quarter 2002 and in 4 quarter 2003 The second antibiotic use research was performed in surgical departments of multiple-discipline state hospital(60 beds) and private surgical hospital (45 beds) 300 case histories of patients in 2000 and 300 in 2003 in every of two hospitals were chosen.

10. Antibiotic use research in outpatient departments 10 outpatient case histories patients with ARD and ten outpatient case histories patients with acute bronchitis analyzed and special questionnaire with following questions were elaborated: • total number of drugs prescribed • number of antibiotics • number of drugs prescribed as brands • number of generics • number of injection forms • number of drugs included in Kazakhstan ESL

11. Antibiotic use research in two hospitals (private and state) • whether antibiotic prophylaxis before operation were performed • whether antibiotic were prescribe in after operation • treatment outcome • presence of complications after operation • calculation of cost of antibiotics per patient 300 hospital case histories patients after surgical operations were chosen, randomized, in 2000 year and appraisal was hold. Case history analyses were based on questionnaire which has following questions

12. Teaching activity • Teaching program was prepared and hold by Drug Information Center in collaboration with ZdravPlus project and 8 trainings were conducted for 2 years • Protocol and AB standards based on evidence medicine were elaborated by 18 authors for 1 year and inculcated successfully (as sample Scottish standard was used)

13. Results and discussion Practice antibiotics prescribing patient with ARI and acute bronchitis ARI acute bronchitis

14. Practice antibiotic use in surgical department of state and private hospitals state private Antibiotic expenditure decreased on 38,2%

15. Conclusions • Agreement was reached on the need of prudent use of antibiotics, and a process was begun to establish a common list of antibiotics for hospital and outpatient formularies in the Karaganda region • The clinical guidelines “Antibiotic therapy and antibiotic prophylaxis in surgery” were elaborated by DIC and successfully inculcated in Karaganda hospitals • Agreement among health care practitioners, which implies drugs contribution only with prescription and antibiotic use cessation during non-bacterial infection was achieved

16. Recommendations To inculcate program “For prudent use of antibiotics”by means of local antibiotic resistance advisory center creation with independent laboratory foundation (necessary lab equipment and training for lab staff), including following elements: • Antibiotic use monitoring • Determination of bioavailability and bioequivalence level of drugs including antibiotics • Antibiotic formulary creation • Study trainings for health care professionals and patients