Central–Eastern Europe

3.3. Central–Eastern Europe

The significant political and social changes that have taken place in Eastern Europe have caused dramatic changes in healthcare as well. These changes had an impact on antibiotic policies and antibiotic use. In a survey of national and local antibiotic policies in central and eastern Europe, interesting information was obtained about the situation 10 years after the decentralization of state drug policies (Krcméry et al., 2000):

National Policies and Antibiotic Prescribing 561 Ten countries were studied in this survey: Poland, Czech Republic, Slovak

Republic, Hungary, Germany, Austria, Slovenia, Croatia, Bulgaria, and Russia. The survey revealed that Czech Republic and Slovak Republic have the most strict antibiotic policies, followed by Poland, Russia, and Croatia.

In particular a National Antibiotic Committee at a ministerial level exists in Russia, Czech Republic, and Slovak Republic. Only Czech Republic, Slovak Republic, and Russia have a National Antibiotic Formulary. These same coun- tries have hospital-central guidelines for antibiotic use. In Czech Republic, Slovak Republic, and Croatia there are restrictions in the community prescrib- ing of antibiotics by GPs. Furthermore in all countries except Germany and Austria there are restrictions in the use of some antibiotics in the hospital. In most hospitals third and fourth generation cephalosporins, carbapenems, and glycopeptides are restricted and can be used only after consulting an infectious disease physician or pharmacologist.

The republic of Moldova is one of the new countries born after the break- down of Soviet Union and can be used as a representative of these new coun- tries. The establishment of market economy and the existence of 1,500 registered pharmacies in a population of 4.35 million citizens led to a flood of medicines on the market in Moldova. Antibiotics are sold mainly over the counter and even on the streets (Cebotarenco, 2001). Doctors are extremely underpaid and can gain money by selling or prescribing antibiotics. Only one sixth or one seventh of antibiotics are recommended by a doctor. In 1995 a non-government, medical organization, the Association DRUGS, was estab- lished in Moldova. The purpose of this organization was to provide to every interested person unbiased, up to date information on the safety and efficacy of drugs. Since its beginning the Association DRUGS has organized decades of seminars and training sessions on various aspects of rational drug use in the hospitals. Moreover a drug bulletin was published and distributed free of charge to physicians and pharmacists. Through the Association DRUGS a net- work was created for rational drug use in Moldova which included authorities from the Ministry of Health, the National Institute of Pharmacy, Medical and Pharmaceutical University of Moldova, pharmacists, physicians, journalists, and non-government organizations.

Given the chronic under funding that covers only 5–7% of the hospitals needs, the strategy to fight antimicrobial resistance included only training pro- grams for physicians in an attempt to change antibiotic prescribing. Such a pro- gram was developed in 1998–9 with the support of APUA and the United States Pharmacopoeia in collaboration with the Association DRUGS. The program had five components (Cebotarenco, 2001).

1. Questionnaire assessment of knowledge, attitude, and practice survey (KAPS) of middle and lower lever pediatricians.

562 Moyssis Lelekis and Panos Gargalianos

2. “Improving antibiotic use” training.

3. Distribution of the manual of antibacterial therapy in Russian to the partic- ipants of the training issued by US Pharmacopoeia.

4. Distribution of the APUA Newsletter among paediatricians and publish- ing the result of the KAPS survey in the informational bulletin of the Association DRUGS.

5. Using mass media to attract the public’s attention to the topics of antibiotic rational use and antibiotic resistance.