History of antibiotic resistance: have we already done our homework?

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BACKGROUND The problems of the irrational use of antibiotics and the growing side effects of antibioticresistance originate from the past. For centuries our ancestors were faced with diseases causedby microorganisms, struggling with them with all available means. The development of antibiotic resistance may occur if: • The patient takes antibiotics without a doctor's prescription; • The doctor does not have the proper qualifications; • The patient has low immunity due to illness (HIV, chemotherapy for cancer); One of main risk factors of antibiotic resistance is an inappropriate using of them. Thisproblem has three sides: patient-doctor-pharmacist. Antibiotics are prescription drugs. In Russiait is law regulated by the Ministry of Health. But the last changing of sale rules in 2017 caused anegative reaction both among the population and in pharmaceutical community. Patients do notfeel the need to visit a doctor and get a prescription. Today we understand that responsible self-medication is an important component in the interaction between the patient, doctor andpharmacist. In conditions when over-the-counter selling of antibiotics is still possible, and theturnover of this supply is large enough, the patient/consumer is also responsible for the irrationaluse of antibiotics. Aim To obtain data on the awareness of various segments of the population about the rational use of antibiotics and the risks of developing antibiotic resistance. METHODS The problem of antibiotic resistance in Russia and around the world as well is a serious threat to the health all of humanity. It should be analyzed at all levels of health care. Firstly, it is necessary to highlight the problem at the legislative level. Secondly, we should remember that medical workers play the main role in the development of antibiotic resistance, in particular, pharmacists who dispense drugs to the public. RESULTS General characteristics of respondents: 51 pharmacists: Gender: male - 14; female - 37; Age: 23-35: 33 ; 36-50: 10; 50>: 8; Work experience: <5: 17; 6-15: 16; 15>: 18; Education: higher- 13; secondary- 38; 233 adults: Gender: male - 48; female - 185; Age: 23-35: 87 ; 36-50: 101; 50>: 45; Education: higher - 225; secondary - 8; Marital status: single - 60; married - 173; Children: yes - 72; no - 161; 30 doctors: Gender: men - 7; women - 23; Age: 25-35: 4 ; 36-50: 16; 50>: 10; Work experience: <5: 2; 6-15: 17; 15>: 11; Education: higher- 30; secondary- 0. Each study group was asked to fill out a questionnaire. For a survey of potential patients were selected questions, according to which we can identify the severity of the issue of self-treatment. Questions for pharmacists were designed in such a way that it was possible to assess their competence in assisting the patient, complying with the laws when selling prescription drugs, as well as their pharmaceutical literacy. To determine the degree of communication between the doctor-patient-pharmacist, we conducted a survey among doctors both at public clinics and among doctors at private clinics. Analyzing the data we obtained the following results: The only question that became common for each of the groups was about interest in the news of the pharmaceutical industry. The most interested were doctors from private clinics. We can connect this with the fact that they have close contact with medical representatives, as well as are interested in improving their professional literacy. Adults result: 1) 80% interviewed adults always buy antibiotics without any prescriptions; 2) About half of the respondents are ready to refuse self-treatment, but on condition that doctors treat them more attentively and free; 3) 73% of them bought antibiotics when they got a flu; 4) About 50% know what drug’s intolerance is; 5) 91% adults do not know if they ever have an antibiotic resistance. Pharmacists result: 1) We compared the answers of pharmacists with higher and secondary education to the question of knowing the definition of the concept of antibiotic resistance (96% / 78%); 2) Both categories of surveyed pharmacists sell antibiotics without a prescription; 3) Only 13% are interested in pharmaceutical news; 4) 23% interviewed pharmacists could sell pills to underage; 5) 97% notify hospitals in case of getting wrong prescriptions. Doctors result: Doctors from private clinics in contrast to the doctors from public policlinics give to their patients not only prescriptions for medicines but also carry out their careful selection. In a private clinic, the doctor may allow more time to be given to the patient, thereby improving the quality of treatment in general. DISCUSSION According to the results we obtained the following important factors in solving the problem of antibiotics self-medication: -education - pharmaceutical literacy is necessary for everyone, because recognizing the problem of antibiotic resistance worldwide, we, as doctors and pharmacists, are obliged to conduct proper consultation to patients; -age - based on the results of the survey, we found that the older the patient, the more responsible his approach to his health; -salary and type of employment - doctors and pharmacists are afraid of losing a high income and thus more closely follow the rules for the appointment and release of antibiotics. CONCLUSION In order to restrain the development of antibiotic resistance not only in our town but worldwide, there must be adequate monitoring of the safety of using of antibiotics and effective monitoring of their availability to the public. Our research show that as more educated doctor and pharmacists as more they want to develop their skills and the more competent help will be given to the patient. In case of this points patients wouldn’t have a possibility to treat them by themselves.

About the authors

A I Zotova

N.N. Burdenko Voronezh State Medical University

Voronezh,Russia

N S Preobrazhenskaya

N.N. Burdenko Voronezh State Medical University

Voronezh,Russia

T A Berezhnova

N.N. Burdenko Voronezh State Medical University

Voronezh,Russia