Rational Use Of Antibacterial Drugs Research Articles

Analysis of the Current Situation and Risk Factors of Lower Respiratory Tract Infection among ICU Patients in Guizhou, China During 2019–2022

Objective: This study aims to explore the prevalence, features, and risk factors of lower respiratory tract infections (LRTIs) in the intensive care unit (ICU) of a newly established hospital in Zunyi City. The goal is to devise strategies for preventing LRTIs in the ICU of new hospitals, thereby mitigating the incidence of nosocomial LRTIs in ICU patients. Methods: A case-control study was conducted from March 2019 to December 2022 to investigate the incidence rate of LRTIs in the ICU of a newly constructed hospital in Zunyi City. Patients with LRTIs constituted the case group, while those without LRTIs constituted the control group, where a 1:1 matching principle was adhered to. A single-factor chi-squared (χ2) test was employed to analyze the risk factors, with independent risk factors being explored using a multivariate logistic regression analysis. Results: A total of 169 strains of pathogenic bacteria were isolated, comprising 66.28% gram-negative bacteria, 17.75% gram-positive bacteria, and 15.97% fungi. The most prevalent pathogens included Acinetobacter baumannii (43.20%), Candida albicans (10.65%), and Pseudomonas aeruginosa (8.88%). Of the 82 strains infected by multidrug-resistant bacteria in patients with LRTIs, 81.7% were carbapenem-resistant Acinetobacter baumannii, 9.8% were multidrug-resistant Pseudomonas aeruginosa, and 6.1% were carbapenem-resistant Escherichia coli. Identified risk factors included smoking history, total hospitalization days, ICU stay length, hypoproteinemia, indwelling gastric tube, intubation type, duration of mechanical ventilation, usage of antibacterial drugs, and administration of protein drugs (P < 0.05). Multivariate logistic regression analysis demonstrated that these factors were independent risk factors for nosocomial LRTIs in ICU patients (P < 0.05). Conclusion: ICU patients in our hospital were mainly infected by carbapenem-resistant Acinetobacter baumannii. To prevent LRTIs in patients, tailored preventive measures should be developed and the rational use of antibacterial drugs should be promoted.

Structure of the probiotic market in Russia

The article provides an overview of the Russian market of probiotic products, taking into account the registration of products of domestic and foreign production in the segments of medicines for veterinary use and animal feed additives by conducting a content analysis of the state information system. The increase in consumer preferences in favor of natural products is the main factor influencing the growth of the market. The growing demands of consumers for the maintenance and breeding of animals using biologically active feed additives, including complex functional probiotic products, stimulate the expansion of the market. The demand for veterinary probiotics has also increased due to the global trend of combating antibiotic resistance and the rational use of antibacterial drugs, pesticides and agrochemicals. Rational use of available antimicrobial veterinary drugs is becoming increasingly necessary, taking into account the spectrum of their activity and the profile of antibiotic resistance of the main pathogens, as well as the development of comprehensive animal treatment programs using alternative products. In many countries, scientists recommend the use of probiotics for the preservation and correction of intestinal biocenosis starting from the first hours of animal life. The ways of using probiotics, their component composition, and the types of target animals have expanded. Probiotics are used as preparations for veterinary use, feed additives to correct intestinal dysbiosis in animals, restore the resident microflora of animals, as well as to improve various production indicators.

Analysis of the tendencies and dynamics of electronic receipt prescribing for antibiotics and their electronic dispensing in Ukraine and Lviv region

Uncontrolled use of antibiotics (antibacterial, antimicrobial agents) leads to the growth of antibiotic resistance, which has become a global health problem. E-prescribing should increase the population's access to medical and pharmaceutical care.
 The purpose of the study: to establish the general trends of electronic prescribing of antibacterial drugs in Ukraine since its introduction in August 2022 and the impact of receipt e-prescribing on the controllability of antibiotic use, as well as to analyze the dynamics of the number of prescribed and dispensed electronic prescriptions for antibacterial drugs.
 We used the following research methods: informative, comparative and retrospective analysis of the dynamics of e-prescriptions for antibiotics. For this purpose, we used the e-data dashboards of the National Health Service of Ukraine (NHSU) and the data of the ENT KP «Pharmacy No.1» in Lviv for the period 08. 2022–05. 2023.
 In general, Lviv region is consistently in the top three, five or ten regions according to certain indicators. It was established that Lviv region is on the third place in Ukraine in terms of the number of issued e-prescriptions for antibiotics, on the first place in terms of the number of dispensed specified prescriptions, but in terms of the ratio of the number of issued e-prescriptions to those issued, Lviv region is in tenth place. The e-data of the National Health Service of Ukraine shows the nomenclature and number of electronic prescriptions of antibacterial drugs, the number of e-prescriptions that have been released, which are registered in the e-healthcare system. However, during the period of martial law, data on antibacterial drugs dispensed according to paper prescriptions or information certificates, equivalent to them, are not recorded. Thus, the e-data reflect the actual consumption of only those antibiotics that are recorded through the redemption of e-prescriptions, i.e. cover only one prescription segment.
 It is shown that although e-prescribing increases the control over the prescription of antibiotics, however, in force majeure circumstances of wartime, e-dispensing does not reflect the real picture of antibiotic consumption in general, but only one segment that is recorded in the e-system of health care. However, it is impractical to introduce an exclusively electronic prescription for antibiotics under martial law, as this carries the risk of limiting access to medical care. The use of the e-system allows to establish control over the quantitative indicators and assortment composition of antibiotics prescribed by doctors, which is definitely a necessary stage for improving the rational use of antibacterial drugs and combating antibiotic resistance.

Antibiotic resistance of Klebsiella pneumoniae and practical significance for veterinary medicine

For successful pharmacotherapy of animals, species identification of pathogens, analysis of antibiograms and interpretation of the results, and laboratory monitoring of the mechanisms of antibiotic resistance are important. This is necessary for veterinarians to rationally select antibacterial drugs and predict their clinical effectiveness. In veterinary clinics, antimicrobial therapy requires review of therapeutic efficacy more often than other treatments.Klebsiella are widely distributed in nature. These microorganisms are often etiological factors in septicemia in cattle, birds, horses, pigs, as well as in the development of infectious diarrhea in young farm animals.The purpose of the study is to study the antimicrobial resistance of Klebsiella pneumoniae isolated from dogs and its practical significance for veterinary medicine.Materials and methods. The microorganism K. pneumoniae was isolated from wound contents in a dachshund dog. The dog was observed in the intensive care unit in the veterinary clinic.The sensitivity to antibacterial drugs was assessed by the method of diffusion of antibiotics into agar.Research results. In the period from 2021 to 2022, a total of 100 isolates were isolated from dogs with purulentinflammatory processes, among which 18% are gram-negative and 82% are gram-positive microorganisms, and the case of Klebsiella pneumoniae isolation is 1%.The isolates of Klebsiella pneumonia were characterized by resistance to aminoglycosides (gentamicin, tobramycin, amikacin), III generation cephalosporins (cefotaxime, ceftriaxone, ceftazidime), IV cephalosporins (cefepime), penicillins (Amoxicillin/clavulanic acid), carbapenems (imipenem, meropenem, doripenem, ertapenem). ), fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin), aminoglycosides (gentamicin, amikacin, tobramycin) and a number of other antimicrobial drugs (sulfamethoxazole trimethoprim). Klebsiella was highly sensitive only to fosfomycin.When analyzing this antibiogram of Klebsiella pneumoniae, it is necessary to conduct additional laboratory studies in order to establish the minimum inhibitory concentrations of antibiotics and to study the mechanisms of resistance.Conclusion. Among strains of Klebsiella pneumoniae isolated from wound exudate in dogs, there is a spread of resistance to most antibiotics, as well as an increase in resistance to cephalosporins and carbapenems. It is necessary to carry out laboratory control of antibiotic resistance for further rational use of antibacterial drugs.

Rational choice of antibiotic therapy in children with acute respiratory infections of the upper respiratory tract

Acute respiratory infections are leading in the structure of infectious pathology in children. Despite the high importance of viruses in the etiology of acute respiratory infections, the role of bacterial pathogens remains important. Features of the current course, high frequency of complications, unreasonable prescription of antibacterial drugs and the risk of developing drug-resistant forms of microorganisms require adherence to algorithms for the timely diagnosis of bacterial infections and the rational use of antibacterial drugs. In the article, on the example of the analysis of clinical cases, the main stages of diagnosis and algorithms for choosing the initial antibiotic therapy for acute respiratory infections of the upper respiratory tract in children in an outpatient setting are considered. In the first clinical case, the principles of differential diagnosis of viral and bacterial acute otitis media, the risks of adverse outcome are considered, the main indications for prescribing systemic antibiotic therapy in preschoolers are identified. The second clinical case demonstrates the algorithms for diagnosing bacterial sinusitis, the possible masks of the disease, and the selection of a starting antibacterial drug. The example of the third clinical case shows the etiological diversity of acute tonsillopharyngitis in children, defined indications for systemic antibacterial therapy. It has been noted that only streptococcal tonsillopharyngitis is the primary indication of antibacterial prescription. The features of initial therapy and the duration of the course of antibacterial drugs in children were determined.

Factors Influencing the Prescription of Antibacterial Drugs in COVID-19 Patients: An Antibacterial Surveillance Study

Introduction: The empiric use of antibiotics in Coronavirus Disease-2019 (COVID-19) infection is not routinely recommended unless a secondary bacterial infection is suspected or confirmed. However, there have been reports of widespread antibiotic use in COVID-19 patients, despite a low rate of secondary bacterial co-infection. Therefore, this study aims to understand the factors influencing the empirical prescription of antibacterial drugs in Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients in Indian settings, as the available data is sparse and conflicting. Aim: To determine the factors associated with antibacterial prescription in patients with proven COVID-19 infection at a tertiary care hospital. Materials and Methods: An antibacterial surveillance study was conducted at Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India. The study duration was two months, from September 2020 to October 2020. The study included COVID-19 patients admitted to critical and non-critical COVID-19 Care Units. Patient data, including demographics, general and systemic examination details, biochemistry, pathological and microbiological reports, and treatment details, were collected using a specially designed form. Patients who were prescribed antibacterial drugs (other than repurposed antibacterial drugs for COVID-19 treatment) were considered as cases, while the rest were classified as controls. The Hazard Ratio (HR) for factors associated with antibacterial prescription was estimated using Cox regression analysis with the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The study included 200 patients, of whom 45 (22.5%) received antibacterial drugs and were classified as cases, while the remaining 155 (77.5%) received antibacterial drugs and were classified as controls. The median age of cases and controls was 59 and 46 years, respectively. Cox regression analysis showed that procalcitonin >1 ng/mL (HR: 1.074, 95% Confidence Interval [CI]: 1.009-1.142, p-value=0.02) and admission to the critical care unit were independent predictors of antibacterial prescription. Additionally, high-dose steroid use (>120 mg/day of Methylprednisolone [MPS]) was associated with a 20% higher risk of antibacterial prescription, although the values were statistically non-significant (HR: 1.203, 95% CI: 0.503-2.879, p=0.678). Conclusion: Admission to critical care units and procalcitonin levels >1 ng/mL were identified as independent predictors of antibacterial prescription in COVID-19 patients. Compliance with hospital-based standard treatment guidelines promotes the rational use of antibacterial drugs.

Meropenem for children with severe pneumonia: Protocol for a randomized controlled trial.

Background: Pneumonia, caused by infection or other factors, seriously endangers the health of children. Meropenem is an effective broad-spectrum antibiotic using in the treatment of infectious diseases. In the therapy of pneumonia, meropenem is mostly employed for the treatment of moderate to severe pneumonia. Previously, we established a population pharmacokinetics (PPK) model for meropenem in pediatric severe infection and simulated the control rate of the time during which the free plasma concentration of meropenem exceeds the minimum inhibitory concentration (MIC) is 70% of the dosing interval (70% fT > MIC). Therefore, we plan to conduct a multicenter randomized controlled trial (RCT) to compare the efficacy and safety between conventional regimen and model regimen for meropenem in pediatric severe pneumonia. Methods: One hundred patients (aged 3months to 15years) will be recruited in this RCT. They will be assigned randomly (at a 1:1 ratio) to a conventional treatment group (20mg/kg, q8h, with 0.5-1h infusion) and a model treatment group (20mg/kg, q8h, with 4h infusion). The primary outcome will be 70% fT > MIC. Secondary outcomes will be the prevalence of meropenem therapy failure, duration of antibiotic therapy, changes in levels of inflammatory indicators, changes in imaging examination results, and prevalence of adverse events. Ethical approval of our clinical trial has been granted by the ethics committee of Beijing Children's Hospital ([2022]-E-133-Y). This trial has been registered in the Chinese Clinical Trial Registry (ChiCTR2200061207). Discussion: Based on our previous PPK data, we have designed this RCT. It is hoped that it will promote rational use of antibacterial drugs in children suffering from severe pneumonia. Clinical Trial Registration: http://www.chictr.org.cn identifier, ChiCTR2200061207.

Effective antibiotic therapy for community-acquired otorhinolaryngological respiratory infection (clinical description)

The State Report on the state of sanitary and epidemiological well-being of the population in the Russian Federation speaks of the continued growth of respiratory infections, reaching more than 33 million cases and amounting to more than 606 billion rubles of direct economic damage in 2021. Of particular importance is the new coronavirus infection SARS-CoV-2, and manifestations of its various new genovariants, for example, variant B.1.1.529 called omicron, causes various inflammatory nosologies on the part of the mucous membranes of the ENT organs (acute rhinosinusitis, acute tonsillopharyngitis, acute otitis media). The viral agent, damaging the epithelium of the upper respiratory tract, creates favorable conditions for the activation of the microbial flora. Identification of a respiratory agent is most often carried out only in severe cases of the disease, so the basic diagnosis is based on clinical symptoms. The relevance of studying the rational use of antibacterial drugs in the treatment of community-acquired respiratory infections in practical otorhinolaryngology is associated not only with the frequency of occurrence, but with a high risk of complications. As a rule, antibacterial drugs are actively used in the complex therapy of acute bacterial etiology of the upper respiratory tract. Due to the high variability and increasing antibiotic resistance, antimicrobial agents are not always rationally used for outpatients. In this context, as noted in the clinical guidelines, one of the topical issues is the rational dosed use of antibacterial drugs in accordance with the pharmacokinetics, pharmacodynamics and efficacy of prescribing a cephalosporin antibiotic in the form of dispersible tablets in the treatment of patients with acute inflammatory diseases of the upper respiratory tract and ear, as an example, clinical cases.

Investigation on knowledge level about rational use of antimicrobial drugs among pharmacists in medical institutions in Shanxi province, China

ObjectiveTo investigate the pharmacist's knowledge about rational use of antimicrobials in Shanxi of China, so as to find out the problems and provide support for the management of antimicrobials. MethodsA questionnaire survey was conducted, which included the basic information of the respondents, the basic knowledge about antimicrobial management and the related knowledge about antimicrobial drugs. SPSS 25.0 was used for statistical analysis. ResultsA total of 462 pharmacists were investigated. The average score of the knowledge related to rational use of antimicrobials was 10.49 ± 4.05. It showed that the hospital type, grade, pharmacist's education, professional title and years of experience had effect on the pharmacist's knowledge level about antimicrobial drugs (P < 0.05). Multivariable logistic regression analysis showed that hospital grade and pharmacist's education were the main influencing factors (P < 0.05). ConclusionPharmacists have insufficient knowledge about the rational use of antibacterial drugs. It is essential to strengthen the training in management regulations and application of antibacterial drugs.

Infectious complications following chimeric antigen receptor T-cell therapy for a hematologic malignancy within 28 days

目的探讨血液肿瘤患者在回输嵌合抗原受体T细胞（CAR-T细胞）后28 d内感染的发生率、临床和微生物学特征及危险因素。方法回顾性分析2016年1月至2020年12月在华中科技大学同济医学院附属协和医院血液科成功接受CAR-T细胞输注的170例血液肿瘤患者基线资料以及回输后28 d内发生感染的临床与病原菌特征。使用泊松回归评估基线特征与感染密度的相关性，单因素和多因素Cox比例风险回归模型评估CAR-T细胞回输后感染的高危因素。结果170例患者中急性淋巴细胞白血病（ALL）72例、非霍奇金淋巴瘤（NHL）56例、多发性骨髓瘤（MM）42例，99例患者在28 d内共发生119次感染，累积感染发生率为（58.2±3.8）％；其中细菌感染98次（45.9％），总感染密度为2.01，首次感染发生的中位时间为回输后12（1～18）d。多因素泊松回归显示ALL患者、难治性疾病、既往30 d内感染病史、回输前ANC<0.5×109/L、前期治疗方案≥4种的患者在28 d内与感染密度有更高的相关性；多因素Cox回归显示≥3级细胞因子释放综合征（CRS）是发生感染的独立危险因素（HR＝3.74，95％CI 1.29～5.72，P<0.001）。结论感染是血液病患者CAR-T治疗后常见的并发症之一，不同肿瘤的感染发生率与类型有所差异，但均以细菌感染为主。ALL患者、难治性疾病、既往30天内感染病史、回输前ANC<0.5×109/L、前期治疗方案≥4种与感染密度相关；3级以上CRS是感染发生的独立危险因素。中国临床试验注册中心：ChiCTR-OIC-17011180、ChiCTR1800018143

Bovhyaluronidaze azoximer as an antimicrobial alternative in companion animals

Antimicrobial resistance formation in various bacteria is a serious biosafety threat. In this regard, the important issue in medical and veterinary fields is not only the rational use of antibacterial drugs, but also the search for ways to significantly reduce the need for antibiotics. Three studies designed to research into these challenges are described. The results indicated that (1) the bacteriuria presences in 62.4 +/- 4.1% of urine samples obtained from companion animals (the microflora count in urine samples is estimated from ‘++’ to ‘Entire Field-of-View’); (2) 16.3 +/- 4.0% of samples from companion animals showed bacteria with low antibiotics sensitivity, and 8.1 +/- 3.0% of samples contained bacteria resistant to 30 antibiotics included in the susceptibility test; (3) the Bovhyaluronidaze azoximer reduce antimicrobial therapy duration statistically significant (p=0.0089). The studies were conducted at the facilities of St. Petersburg State University of Veterinary Medicine and Bars veterinary clinic chain in St. Petersburg, Russia. A randomized clinical trial of Bovhyaluronidaze azoximer effect on course of disease and treatment duration of acute and chronic prostatitis and urocystitis, including complicated by urolithiasis, was conducted in 54 animals. Animals were randomly assigned to intervention (n=34) and control (n=20) groups. The animals of both groups received the antimicrobial therapy. Interventional group patients additionally received Bovhyaluronidaze azoximer in the form of rectal suppositories. The antimicrobial therapy mean duration in intervention group animals took 14.88 +/- 4.98 days, in control group animals — 18.65 +/- 5.40 days. The study findings imply that bacteriuria is widely prevalent in companion animals and antimicrobial resistance is increasing issue in veterinary medicine. Bovhyaluronidaze azoximer contributes to microcirculation restore and increases the bioavailability of antibacterial drugs at the site of infection. This makes its relevant for use in the complex treatment for septic and inflammatory processes. This allows to reduce the antimicrobial course duration (and completely decline antibiotic therapy in some cases) and prevent the formation of chronic inflammation and infection sites.

Analysis of Common Pathogenic Bacteria and Drug Resistance of Biliary Tract Infection in Nanjing Area

Background: Analyze the distribution and drug resistance of pathogenic bacteria that cause biliary tract infections in Nanjing, and provide evidence for the rational use of antibacterial drugs in clinical practice. Methods: Clinical strains isolated from bile specimens of patients suspected of biliary infection in the First Affiliated Hospital of Nanjing Medical University in 2019 were collected, The drug susceptibility criteria are based on the standards published by the National Standardization Committee of the US Clinical Laboratories. WHONET 5.6 software was used to analyze the distribution of pathogens and drug resistance. Results: A total of 693 strains of pathogenic bacteria were isolated, including 448 Gram-negative bacteria(64.6%), 245 Gram-positive bacteria (35.4%). The top three pathogens were 210 strains of Escherichia coli(30.3%), 87 strains of enterococcus faecium (12.6%), 76 strains of klebsiella pneumoniae (11.0%), The resistance rates of Escherichia coli to ampicillin, cefuroxime, cefazolin, ceftriaxone, piperacillin and ampicillin / sulbactam were 80.1%, 69.4%, 67.3%, 64.1%, 63.6% and 62.8%, The resistance rates of Klebsiella pneumoniae to ampicillin / sulbactam, cefuroxime and cefazolin were 65.8%, 64.5% and 61.1%, The resistance rates of Enterobacter cloacae to ceftriaxone, ceftazidime and aztreonam were 56.2%, 53.1% and 53.1%, The resistance rates of Enterococcus faecium to moxifloxacin, clindamycin, erythromycin, penicillin G, ampicillin, ciprofloxacin and levofloxacin were 100%, 90%, 76%, 72.1%, 64.4%, 64% and 62%. Conclusions: Pathogens of biliary tract infections are mainly Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae, followed by Enterococcus faecium and Enterococcus faecalis. There were many drug-resistant bacteria, so we should pay attention to bile specimen culture and drug sensitivity test.

The Intervening Effect of Preventive Use of Antibacterials During the Perioperative Period in Orthopedic Department

Objective: To assess the effect of orthopedic perioperative antibiotic prophylaxis intervention by clinical pharmacist. Methods: 1467 hospitalized patients in department of orthopedics with perioperative records in eight months in 2019 were chosen. 597 surgical cases before intervention were sampled as the control group, and 870 surgical records were sampled as intervention group. Investigation and analysis were performed in orthopedic perioperative prophylactic antibiotics. Results: Compared with the control group, the intervention group showed increased rationalities and decreased irrationalities in perioperative antibiotic prophylaxis. The unreasonable external use of teicoplanin was significantly decreased, and the postoperative prophylaxis duration was significantly shortened. There were no significant difference in the timing of perioperative antibiotic prophylaxis between two groups. Conclusions: After interventions for the preventive use of antibacterial drugs in orthopedic perioperative period, the rational use of antibacterial drugs has been significantly improved, the irrational use of drugs has been improved, and the effect of drug treatment has been improved. However, there is still a gap between the rational use of antibacterial drugs. Further strengthen supervision and management.

Клиническая фармакология антибактериальных препаратов в педиатрии

Currently, the use of antibacterial drugs is one of the most frequently recommended methods for treating a large number of infectious diseases. However, there are many cases of unjustified antibacterial therapy, errors in the use of antibiotics, irrational combinations, and undesirable drug reactions. And that is why the problem of rational antibiotic therapy remains relevant in modern medicine - the rational use of antibacterial drugs, compliance with strict indications for the use of antibiotics, certain schemes and principles of their use, and the creation of protocols for antibacterial therapy in pediatric practice. The purpose — to present the key issues of clinical pharmacology of antibacterial drugs in Pediatrics. Results. A large number of different microorganisms act as etiological factors of frequent, repeated respiratory diseases. Antibacterial drugs should be prescribed for inflammatory diseases of bacterial etiology and for perioperative prevention. Antibiotics should not be used in the treatment of uncomplicated acute viral respiratory diseases, since they do not have an antiviral effect, do not reduce the temperature, and do not prevent the development of bacterial complications. Conclusion. Thus, today a doctor has a large arsenal of antibacterial drugs and faces a very important task — to use this arsenal rationally. When choosing antibiotics, there are problems associated with the presence of a large number of drugs, the proposed combinations and treatment regimens, polypragmasia, ignorance of modern treatment standards, and a low level of knowledge of clinical pharmacology. In the treatment of life-threatening infections, the cost of the antibiotic should not prevail over the factors of effectiveness and safety.

Bovhyaluronidaze azoximer as an antimicrobial alternative in companion animals

Antimicrobial resistance formation in various bacteria is a serious biosafety threat. In this regard, the important issue in medical and veterinary fields is not only the rational use of antibacterial drugs, but also the search for ways to significantly reduce the need for antibiotics. Three studies designed to research into these challenges are described. The results indicated that (1) the bacteriuria presences in 62.4 +/-4.1% of urine samples obtained from companion animals (the microflora count in urine samples is estimated from ’++’ to ’Entire Field-of-View’); (2) 16.3 +/-4.0% of samples from companion animals showed bacteria with low antibiotics sensitivity, and 8.1 +/-3.0% of samples contained bacteria resistant to 30 antibiotics included in the susceptibility test; (3) the Bovhyaluronidaze azoximer reduce antimicrobial therapy duration statistically significant (p=0.0089). The studies were conducted at the facilities of St. Petersburg State University of Veterinary Medicine and Bars veterinary clinic chain in St. Petersburg, Russia. A randomized clinical trial of Bovhyaluronidaze azoximer effect on course of disease and treatment duration of acute and chronic prostatitis and urocystitis, including complicated by urolithiasis, was conducted in 54 dogs. Animals were randomly assigned to intervention (n=34) and control (n=20) groups. Animals of both groups received the antimicrobial therapy. Interventional group patients additionally received Bovhyaluronidaze azoximer in the form of rectal suppositories. The antimicrobial therapy mean duration in intervention group animals took 14.88 +/-4.98 days, in control group animals — 18.65 +/-5.40 days. The study findings imply that bacteriuria is widely prevalent in companion animals and antimicrobial resistance is increasing issue in veterinary medicine. Bovhyaluronidaze azoximer contributes to microcirculation restore and increases the bioavailability of antibacterial drugs at the site of infection. This makes its relevant for use in the complex treatment for septic and inflammatory processes. This allows to reduce the antimicrobial course duration (and completely decline antibiotic therapy in some cases) and prevent the formation of chronic inflammation and infection sites.

Rational antimicrobial chemotherapy: assessment of the level of basic knowledge of general practitioners. Final results of the KANT project

Introduction: The irrational use of medicines leads to a decrease in the quality of care, an increase in treatment costs and side effects. In the case of antibacterial drugs, in addition to all the above-mentioned consequences, their improper use can lead to an aggravation of the existing and quite challenging problem of our time – the growth of antibiotic resistance among pathogenic microorganisms.&#x0D; The aim of the study: to determine the level of basic knowledge of medical specialists in the field of a rational use of antimicrobial drugs (AMD).&#x0D; Materials and methods: The study was based on an analysis of an anonymous multicenter survey in the framework of the KANT project (the full name of the project is “Physicians’ (Students’) Knowledge of Antimicrobials Usage”). It was conducted in 2018–2019 in 10 major centers of Russia.&#x0D; Results and iscussion: According to the results of the study, the respondents showed a low level of knowledge of the rational use of antibacterial drugs. The best results are obtained for questions No.1 (time interval for evaluating the effectiveness of the initial antimicrobial therapy (AMT)), No.2 (rationality and period of AMD change with a positive clinical effect), and No.9 (determining the mode of using the proposed drugs), whereas the worst results were obtained for questions No.3 (determining irrational combinations of AMD), No.4 (determining a situation requiring a long course of AMT), and No.7 (choosing auxiliary drugs for bacterial respiratory infections).&#x0D; Conclusion: The results obtained in the study indicate the need for additional educational activities among health professionals.

Recent Development of Pyrimidine-Containing Antimicrobial Agents.

Multidrug-resistant bacterial infections have become an important cause of clinical death in the twenty-first century. Much effort has been made to overcome this challenge. The discovery of novel antimicrobial compounds, as well as the rational use of antibacterial drugs with different structure types and mechanisms, is helping to deal with bacterial resistance. Currently, pyrimidine-containing agents are the major areas of new antibacterial drug discovery. Given their good activities and diverse mechanisms of action, many pyrimidine-containing heterocyclic compounds have become the focus of interest for many scientists. In addition, pyrimidine structure is an important part of many endogenous substances, which is an advantage that allows pyrimidine derivatives to interact with genetic materials, enzymes and other biopolymeric substances in the cell. Scientists have focused on the discovery and structural optimization of pyrimidine derivatives, which has resulted in the discovery of many novel pyrimidine derivatives with intriguing profiles. Herein we summarize the therapeutic potentials of pyrimidine compounds that are promising for antimicrobial applications over the last decade. In particular, the relationships between the structures of modified pyrimidines and their antimicrobial activity are systematically discussed.

The experience of using a bacteriophages-based complex antibacterial and analgesic drug in gel formulation in women who underwent various instrumental and diagnostic and treatment interventions

During the spread of bacterial infections with extensive drug resistance, the potential of existing antibacterial drugs is significantly reduced. The medical community is seeking opportunities for the rational use of antibacterial drugs, the development of new drugs, as well as the use of alternative treatments for these infections.&#x0D; Aim. The objective of this study was to evaluate the effectiveness of the use of a complex antibacterial and analgesic drug based on bacteriophages in gel form during various instrumental studies and diagnostic procedures in order to minimize the risk of the urinary system infections complications.&#x0D; Materials and methods. The study included 235 women aged 18 to 75 years who underwent treatment at the Moscow State Clinical Hospital named after Spasokukotsky and in the clinic of urology of Moscow State University of Medicine and Dentistry from September 2019 to January 2020. During the manipulation, all patients of the main group (n=120) used a developed preparation based on bacteriophages, and in the control group (n=115), a topical gel based on chlorhexidine dihydrochloride and lidocaine hydrochloride was used. All patients before the manipulation, as well as 10 days after the manipulation, underwent bacteriological analysis of urine. Efficiency assessment was carried out on the basis of laboratory data obtained, as well as according to the visual analogue scale of the pain syndrome severity.&#x0D; Results. None of the patients in the main group showed intolerance, side effects and allergic reactions of the developed drug based on bacteriophages. Bacteriological analysis of urine received before manipulation in both groups showed the absence of clinically significant titers of pathogenic bacteria, while 1 week after manipulation the number of titers of pathogenic bacteria (104) was significantly higher in the control group (p0.04). In patients of the main group, the incidence of dysuria was lower compared with the control group (p0.05).&#x0D; Conclusion. The study showed good tolerance of the developed drug and its clinical effectiveness in reducing the number of symptomatic bacteriuria; severity of pain after undergoing manipulation was relatively lower in the main group of patients. Conducting multicenter studies with the inclusion of a larger number of patients in the future will reduce the economic costs associated with treating patients by reducing the number of cases of nosocomial infections and reducing postoperative time spent by patients in the hospital.

Analysis of the problems of the rational use of antibacterial drugs in Ukraine

Aim. To analyze the current situation with the antibacterial drugs turnover, as well as to develop effective ways to solve the problem of growing resistance of bacteria to antibiotics, including determination of the active role of a pharmacist in this process. Materials and methods. The analysis of the current situation in the domestic system ofpharmaceutical supply of the population was carried out on the basis of a survey of pharmaceutical specialists directly involved in the process of dispensing antibacterial drugs from pharmacies in the outpatient setting. In accordance with the aim of the study a questionnaire was developed for interviewing pharmaceutical specialists. The questionnaire included the aim and objectives of the survey. During the survey, the confidential terms of use of the information received were notified. The required size of the respondent sample was calculated taking into account the expected reliability of the results obtained. The questionnaire proposed included closed questions that provided data on the state of the problem of the rational dispensing of antibacterial drugs, as well as open-ended questions revealing the individual attitude of the respondents to the problems of the rational drug consumption from the pharmacotherapeutic group indicated. The questions contained in the questionnaire were divided into two groups: the basic ones allowing us to obtain the necessary information from the respondent and the control ones indirectly confirming the accuracy of answers to basic questions and allowing exclusion of unclear answers. Results. The article presents the results of a survey of pharmaceutical specialists on the problem of the rational supply and consumption of antibacterial drugs and the assessment of their role in organization of an effective prescription model for this group of drugs in Ukraine. It has been determined that a significant majority of respondents consider it necessity to sell antibacterial drugs strictly by prescriptions (90.42 %), but, in practice, approximately the same number of respondents (90.73 %) still dispenses antibacterial drugs without a prescription: “Sometimes” (67.73 %) or “Always” (23.0%). Respondents consider as important measure to implement a set of measures to disseminate knowledge about the rationality of using antibiotics (84.98 %) through the pharmacy network. At the same time, a large majority of respondents (90.10 %) transfer responsibility for the proper consumption of antibacterial drugs onto doctors. According to the opinion of the respondents (42.49 %), the development of an appropriate target program with the involvement of pharmacists and doctors should be the main direction of implementing the strategy of the rational use of antibacterial drugs in Ukraine. Among the factors contributing to the unsystematic use of antibacterial drugs, the leading position by the number of respondents were such answer options as “Thoughtless self-medication of the population” (79.23 %), “Violation of prescription dispensing” (62.62 %) and “Availability of antibiotics in the pharmacy” (47.92 %). Conclusions. According to the results of the study it has been found that the complexity and controversial nature of the problem of the rational consumption of antibacterial drugs in Ukraine requires a comprehensive solution involving all subjects of the pharmaceutical supply system of the population.

ВИСВІТЛЕННЯ ПРОБЛЕМ РАЦІОНАЛЬНОГО ЗАСТОСУВАННЯ АНТИБІОТИКІВ ПРИ ВИКЛАДАННІ ФАРМАКОЛОГІЇ

Мета роботи – аналіз проблем раціонального застосування антибіотиків та шляхів їх вирішення при викладанні фармакології.&#x0D; Основна частина. Проаналізовано основні проблеми, які перешкоджають ефективній антибіотикотерапії у наш час (прогресуюче зростання резистентності мікроорганізмів, нераціональне, надмірне застосування антибіотиків у клінічній практиці) та підкреслено важливість подачі цього матеріалу студентам для усвідомлення ними належних правил використання антибіотиків. &#x0D; Висновок. Аналіз причин антибіотикорезистентності, проблем раціонального призначення антибактеріальних препаратів та шляхів їх вирішення при викладанні теми “Фармакологія антибіотиків” є важливою складовою ефективного опанування студентами цього важливого матеріалу з метою використання у майбутній лікарській діяльності.