World Antimicrobial Resistance Awareness Week: How the Ministry of Health is strengthening the national policy to combat antimicrobial resistance

18-24 November is World Antimicrobial Resistance Awareness Week. According to the WHO, nearly 5 million deaths were attributed to antibiotic resistance in 2019. If antibiotics stop working, 3 out of 10 cases of pneumonia will end in death, 5 out of 1000 women will not survive childbirth, and only a quarter of people with tuberculosis will be cured.

The main reasons for the development of antibiotic resistance are the excessive use of antibiotics and non-compliance with the treatment prescribed by a doctor. As a result of resistance, antibiotics and other antimicrobial drugs (both long-known and newly invented) become ineffective, and infections become difficult or impossible to treat.

What recommendations are important to follow?

• Take antimicrobial drugs only as prescribed by a doctor, never self-medicate!
• Do not use antibiotics in case of viral infections. This recommendation can only be made by a doctor (after examination and additional tests).
• Complete the full course of treatment as prescribed by your doctor, do not skip medication, and do not interrupt treatment even if you feel better.
• Do not use antimicrobials that remain after the course of treatment.
• Do not share antimicrobials with friends or relatives and do not “prescribe” treatment to them.
• Don't skip your schedule and recommended vaccinations.

Antimicrobial resistance is especially dangerous in times of war. It significantly increases the burden on the healthcare system. When used correctly, these medicines save the lives of wounded and sick soldiers. However, if resistance to such drugs has spread, it greatly complicates the treatment and recovery of patients.

To prevent antimicrobial resistance from becoming an even bigger problem, joint efforts are needed from both healthcare professionals and patients. In 2015, the WHO launched a global surveillance system for antimicrobial resistance and use. Ukraine joined it a few years ago and is actively implementing the changes necessary to counter the problem. In particular, the standard “Rational use of antibacterial and antifungal drugs for therapeutic and prophylactic purposes” was amended to include ceftriaxone and levofloxacin as reserve antibiotics. The innovation prohibits the use of these drugs as the first choice, and even more so for prophylactic purposes when the pathogen has not been identified. First, a physician must provide a written justification and approval from a clinical pharmacist before prescribing these antibiotics.

The standard also updates approaches to the principle of antibiotic selection based on the results of bacteriological testing. Now, doctors and clinical pharmacists can more quickly determine which drug to choose if the pathogen is sensitive to several antibiotics: the antibiotic with the lower risk of AMR (in the absence of direct contraindications) is prescribed.

In every hospital (Order of the Ministry of Health of Ukraine No. 1614), regardless of ownership, a system of infection prevention, infection control and administration of antimicrobials is being implemented and strengthened. The set of measures envisaged by this order will improve the fight against the spread of infectious diseases associated with the provision of medical care, strengthen their prevention, reduce the spread of antimicrobial resistance, optimize the use of antibiotics and reduce the financial burden on the hospital.

Currently, the Ministry of Health has developed a new National Action Plan on Antimicrobial Resistance, which has already been submitted to the Government for approval. It provides for the expansion of the national network of microbiological laboratories, strengthening of the infection control system at the level of healthcare facilities, and surveillance of resistant pathogens, taking into account the cross-sectoral approach of the “One Health”.

Additionally: The World Health Organization (WHO) has updated the list of priority bacterial pathogens (Bacterial Priority Pathogens List 2024 - BPPL) that threaten the health of millions of people and require special control by the medical systems of each country. The list was first compiled globally in 2017. The updated version includes 24 pathogens - bacteria that are resistant to antibiotics. They cannot be effectively treated with antimicrobial drugs in the event of an illness (due to the ability of microorganisms to adapt to antimicrobial therapy and become genetically insensitive to a particular type of antibiotic) and can provoke new epidemics or outbreaks of disease in the world.

BPPL-2024 contains 24 pathogens belonging to 15 families of antibiotic-resistant bacterial pathogens. These include gram-negative bacteria resistant to antibiotics of last resort, drug-resistant tuberculosis mycobacteria, and other resistant pathogens such as Salmonella, Shigella, S. aureus, Staphylococcus aureus, and pseudomonas aeruginosa. The addition of these pathogens to the list highlights their global impact in terms of burden, as well as the challenges associated with transmission, treatment options and prevention options. The guide also reflects research and development of new treatments and emerging resistance trends, and provides recommendations for the development of new and needed treatments to halt the spread of antimicrobial resistance (AMR).