It’s necessary to train doctors in the antibiotic stewardship constantly and to extend and coordinate the efforts to achieve the stability!

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Read our last and longest interview of our series “AMR in CEE-countries” on the occasion of the World Antibiotic Awareness Week. Prof. Rossitza Vatcheva-Dobrevska (University Hospital “Queen Joanna”, Sofia) gave us a precious insight into the dealing with this issue in Bulgaria …

Rossitza, this week is an important week for all hospitals around the world. With which activities do you start this week?

During the World Antibiotic Awareness Week, we arrange a series of activities to raise awareness among health care staff, medical students and general public throughout media.
Tomorrow (Nov, 14th), during the lectures with medical students, doctor assistants and midwifes, will be presented the WHO campaign, a factsheet about AMR, antimicrobial stewardship and policy principles as well as infographics and posters. The students will receive leaflets with infographics concerning antibiotic misuse, the role of Infection Prevention and Control in preventing Antimicrobial Resistance in healthcare and how everyone can help prevent AMR.
The day after tomorrow (Nov, 15th) there will be a presentation about AMR and the significance of Infection Prevention and Control (IPC). Furthermore, WHO posters and infographics will be presented to hospital medical staff, and then we have a special meeting. Corresponding information material will be posted on the hospital website.
An interview with me as a clinical microbiologist (responsible for the antibiotic policy and AB stewardship in the University Hospital “Queen Joanna”) in relation to these problems and the WAAW will also be published on the website (under “medical news”).
There will also be a short interview with me in a newspaper as President of the Bulgarian IPC Association “BulNoso” regarding the role of infection prevention and control policy in the AMR chain break.

Do all this inititives help increase awareness? And what are the major BulNOso instruments for its information- and training purposes?

I would like to start with some thoughts of Dr Otto Cars, founder of ReAct (Action on Antibiotic Resistance): “While some physicians had seen the huge impact of antibiotics on health first-hand, many seemed oblivious to the consequences of overuse.” It’s necessary to train doctors in the antibiotic stewardship constantly, and to extend and coordinate the efforts to achieve the stability.
The main purpose of BulNoso is to provide information on European standards and innovations in Infection Control (IC) for a wide range of specialists in clinical and preventive medicine aiming to support their professional development and practice in this field of medicine.
The major BulNoso instruments for its information- and training purposes are: The Scientific Journal “Nosocomial Infections” (BulNoso Bulletin), the renewed website www.bulnoso.org, the National Forum with international participation and educational regional seminars started in 2009 and further developed to become the National Forum BulNoso Academy.
We also presented a study about the emergence and spread of x-drug and pan-drug AMR pathogens. It contained an analysis of the increasing resistance level during the last three years in the Bulgarian University hospital and outpatients care department, as well as the new resistance mechanisms emergence.
The real clinical cases from practice were presented as well. In conclusion, we defined the necessity of creating and implementing specific antibiotics stewardship in outpatient care and actively work with the General Practitioners society. Rapid detection, screening and infection control measures and behavior changes are of paramount relevance for preventing the spread of the major resistance threats through high-risk patients in hospitals.
Fortunately, we see that more and more patients are asking for a microbiology tests before antibiotic treatment. In the hospitals, antibiotic policy documents are updated and followed more strictly.

How hospitals in your country generally deal with this topic?

The system of antibiotic stewardship is working mostly in the university hospitals and regional hospitals as well. The clinical microbiologists in hospitals are responsible for the AB policy writing, consultancy and discussion on the antibiotic treatment with clinicians, de-escalation therapy and changes and patients screening for MDR pathogens. In my hospital, for example, our Microbiology Lab prepared an annual report on AMR in ICU, Abdominal Surgery, Orthopedic and Trauma Surgery, Pediatric Onco-hematology with BMT etc. These reports are presented at joint meetings between clinic and Lab staff where future activities are discussed.

What is about prescription practices in your country?

Antibiotics are under the auspices of Law of medicinal products in human medicine in our country. According this law the medication can’t be sold without doctor’s prescription. Unfortunately, there are a number of cases of violation. Sold medicine without prescription is the most common offense that the Executive Drug Agency is registering. We don’t have exact information regarding the part of antibiotics. The financial fine is between 500 EUR for first time to 2500 EUR for a repeated infringement.
During 2016, the Patient’s Association “Together with you” started a round table, entitled “Rational Antibiotic Use in Children”: Common Mission of Doctors, Patients and Institutions  with the Bulgarian Parliament,  jointly with the Health Committee of  the 43rd  National Assembly,  the Ministry of Health, WHO, the  Bulgarian Medical Association, the Bulgarian Pharmaceutical Union,  the Bulgarian Red Cross, the  National Association of Bachelor Pharmacists in Bulgaria, the Drug Agency, the National Health Insurance Fund and doctors from across the country engaged in antimicrobial resistance survey structures in  the Medical Universities, regional cities, patients’ organizations and media.
Dr. Danilo Lo Fo Wong, Program Manager Antimicrobial Resistance (WHO) Regional Office for Europe, Copenhagen participated with a presentation entitled “WHO Prospects on Proper and Improper Use of Antibiotics in Children”. Dr. Danilo recalled that the main driver for AMR is the misuse of antibiotics, in particular: unnecessary prescription, inappropriate prescription, indiscriminate use of broad spectrum antibiotics, improper use of narrow spectrum antibiotics, wrong length of treatment, dosage, non-use of antimicrobial tests to adjust treatment, self-treatment, pressure by patients on prescribers and financial pressure by pharmaceutical companies.

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Carola Timmel is journalist for print and radio and professional speaker. Her focus lies on the topic Medicine & Health.

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