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.
Parts
» Antibiotic Policies: Theory and Practice
» THEORIES OF FACILITATING CHANGE
» OTHER APPROACHES TO GUIDELINE DEVELOPMENT
» QUALITY ASSURANCE AND DEVELOPMENT OF STANDARDS
» DEVELOPMENT OF CLINICAL STANDARDS IN SCOTLAND
» WHICH QI INTERVENTIONS HAVE BEEN STUDIED IN CAP?
» LINKING PROCESS OF CARE TO OUTCOMES IN QI
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE PROCESS OF CARE IN CAP?
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE OUTCOMES IN CAP?
» Designing and implementing a CAP intervention
» LEVEL OF AGGREGATION OF ANTIMICROBIALS
» ANTIMICROBIAL USAGE MEASURES
» Relationships based on patient-specific data
» Relationships based on aggregate usage
» ANTIBIOTIC CONSUMPTION; ALTERNATIVE UNITS OF MEASUREMENT
» ANTIBIOTIC CONSUMPTION CALCULATOR
» BENCHMARKING FOR REDUCING VANCOMYCIN USE AND VANCOMYCIN- RESISTANT ENTEROCOCCI IN US ICU S
» THE HARVARD EMERGENCY DEPARTMENT QUALITY STUDY
» ANALYSIS BY INDIVIDUAL ANTIMICROBIAL AGENT
» BENCHMARKING WITH OTHER ANTIMICROBIAL UTILISATION DATA
» STATE OF THE ART OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» AUDITING AND IMPROVING THE QUALITY OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» TYPES OF STUDIES TO OBTAIN QUALITY DATA ON A PATIENT LEVEL
» MULTIDISCIPLINARY ANTIMICROBIAL MANAGEMENT TEAMS
» THE ROLE OF THE PHARMACIST IN INFECTION MANAGEMENT
» TRAINING AND SUPPORT IN INFECTION MANAGEMENT FOR PHARMACISTS
» ANTIBIOTIC POLICY IN THE TERTIARY CARE CENTRE
» ANTIBIOTIC CONSUMPTION IN ICU S
» ANTIBIOTIC RESISTANCE IN ICU
» The impact of antibiotic policies and antibiotic consumption on antibiotic resistance
» IT and benchmarking to improve antibiotic prescribing
» COST OF HOSPITAL-ACQUIRED INFECTION
» THE COST OF ANTIMICROBIAL RESISTANCE
» Costs of screening/surveillance cultures
» Isolation, cohorting, and contact isolation
» EPIDEMIOLOGY OF INVASIVE FUNGAL INFECTIONS
» Antifungal resistance in Candida species
» Antifungal resistance cannot be transmitted by extrachromosomal DNA
» RATIONAL USE OF ANTIFUNGAL AGENTS
» THE CHANGING FACE OF VIRAL INFECTIONS AND THEIR MANAGEMENT
» PROBLEMS ASSOCIATED WITH ANTIVIRAL THERAPY
» ANTIVIRAL TREATMENT STRATEGIES
» ANTIVIRAL PROPHYLAXIS STRATEGIES
» ANTIBIOTIC CONCENTRATIONS AT TARGET SITES
» An infant with aplastic anaemia
» A long-standing E. coli infection of liver cysts
» BREAKPOINTS: A SHORT HISTORY AND OVERVIEW
» PHARMACODYNAMIC RELATIONSHIPS AND EMERGENCE OF RESISTANCE
» EVALUATION OF THE ANTIMICROBIAL RESISTANCE SURVEILLANCE DATA PUBLISHED IN THE MEDICAL LITERATURE
» PRACTICAL ASPECTS OF THE IMPLEMENTATION OF THE SURVEILLANCE PROGRAM
» Multivariate analysis methods
» Evolutionary genetic approaches
» Study of the relationship between bacterial resistance and antimicrobial consumption
» To predict the short-term evolution of resistance
» To evaluate interventions to control antibiotic resistance
» DISINFECTANTS: TYPES, ACTIONS, AND USAGES
» Evidence of bacterial resistance to biocides
» Mechanisms of bacterial resistance to biocides
» EVIDENCE OF CROSS-RESISTANCE BETWEEN BIOCIDES AND ANTIBIOTICS
» DISINFECTANT USAGE AND ANTIBIOTIC RESISTANCE
» METHODS OF LITERATURE REVIEW
» PROBLEMS WITH INTERPRETATION OF PUBLISHED STUDIES
» Distribution of educational materials
» Audit and feedback with or without other educational materials
» Educational group meetings or seminars
» Educational outreach/academic detailing
» Financial/healthcare system changes
» EFFECT OF INTERVENTIONS ON ANTIBIOTIC RESISTANCE
» DDD/1,000 INHABITANTS AND DAY (DID)
» PRESCRIPTIONS/1,000 INHABITANTS AND YEAR
» INDICATIONS FOR ANTIBIOTIC PRESCRIPTIONS
» POSSIBLE CAUSES FOR OBSERVED VARIATIONS IN ANTIBIOTIC USE
» DETERMINANTS OF ANTIBIOTIC CONSUMPTION
» COLLECTIVE AWAKENING AND PROGRESSIVE MOBILIZATION OF FRENCH PUBLIC HEALTH AUTHORITIES
» ANTIBIOTIC USE AND COST TRENDS
» IMPACT ON HEALTH BUDGETS OF ANTIBIOTIC USE
» ACCESS TO ESSENTIAL ANTIBIOTICS AT ALL LEVELS OF CARE
» EPIDEMIOLOGY OF ANTIMICROBIAL RESISTANCE
» THREAT OF ANTIMICROBIAL RESISTANCE
» ECONOMIC IMPLICATIONS OF ANTIMICROBIAL RESISTANCE
» FACTORS CONTRIBUTING TO DEVELOPMENT AND SPREAD OF RESISTANCE
» STRATEGIES FOR CONTAINMENT OF RESISTANCE IN DEVELOPING COUNTRIES
» Antibacterial resistance and policies
» Policies, guidelines, and education on antibacterial use
» Discovery, development, and commercialization in the face of policies
» Antibacterial development, labelling, and benefits
» WHAT CAN BE DONE NOW ABOUT ANTIBIOTIC RESISTANCE?
» HOW CAN THE DIAGNOSTIC LABORATORY HELP?
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