“We can see how our grandchildren die of pneumonia.” Deputy head of the Ministry of Health Dubrov about the hidden danger of antibiotics

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Bacterial resistance to antibiotics causes more deaths than HIV or malaria. Only in the USA annually occurs more than 2.8 million infections resistant to antimicrobial drugs.

Antibiotic resistance occurs when bacteria gain the ability to “defeat” the drugs designed to kill them. Persistent infections are difficult to treat, sometimes impossible.

But such a threat does not stop Ukrainians from abusing antibiotics. Sometimes due to ignorance, sometimes – “just in case”.

Why this happens and what you need to know about antibiotics in order not to harm yourself and humanity in general, “Ukrainian Pravda. Life” asked at the First Deputy Minister of Health Serhiy Dubrov.

Serhii Dubrov, first deputy head of the Ministry of Health

– There is a lot of talk about the abuse of antibiotics. But Ukrainians still actively accept them without control. Why does this happen?

– Not even all doctors have an understanding of when to take them and when they absolutely cannot.

What are antibiotics? In 1943, Alexander Fleming synthesized penicillin, which defeats bacteria, for which he received the Nobel Prize. And at that time it seemed that the question was solved, that is, we could kill any bacteria.

But even during his Nobel speech, Fleming said that if the dosage is violated and the irregular use of antibacterial drugs, bacteria can become resistant, that is, insensitive to antibiotics. You and I live at a time when this is already a colossal problem.

The level of resistance, that is, the insensitivity of bacteria to antibacterial drugs in Ukraine is almost the worst in the entire European region. This is due to the incorrect use of antibiotics.

The most striking example is when antibiotics were prescribed in more than 90% of cases during the COVID-19 pandemic.

The doctor must understand what an antibacterial drug is and that it works on bacteria, not the COVID-19 virus.

– What is the harm of using antibiotics?

– Millions, billions of bacteria live in our body. Some bacteria, in contact with antibacterial drugs, of course, die, and some adapt because they also want to live.

These microbes multiply, for example, in the intestine. Why am I talking about the intestine? Because Escherichia coli (Escherichia coli), Klebsiella pneumoniae (Friedlander’s bacillus) are typical inhabitants of our gastrointestinal tract and representatives of the enterobacteria family. They are no longer sensitive to antibiotics.

Even modern antibiotics, which appeared a few years ago on the pharmaceutical market, are no longer effective against Friedlander’s bacillus.

– There is a tradition in Ukraine to drink an antibiotic just in case. Can a person independently understand that he needs an antibiotic?

– A very small range of infectious bacterial diseases can be determined by symptoms. A viral infection can have the same clinical manifestations. In most cases, a blood test is required. This is not a 100% guarantee, but if we see an increase in the level of leukocytes and a change in some other indicators, this indicates a bacterial cause of the disease.

You can also take a procalcitonin test (a biomarker for diagnosing bacterial infections). It will be cheaper than needlessly being treated with an antibiotic. That is, simple research can help establish the cause of the disease and help make a decision about the use of antibiotics.

Unfortunately, some primary care doctors still believe that if the temperature rises above 38°C for three days, even in the off-season, when there is a significant increase in viral infections, antibiotics should be prescribed after three days. But it is not so.

– And what other consequences, apart from resistance, can the human body have when using antibiotics?

– Everything is simple. The kingdom of heaven, eternal peace. The more a person takes antibiotics, the more resistant strains appear. And when a person really has a bacterial complication during another disease, when immunity is weakened, when entering a medical institution, the risk of death increases 2-4 times. This is shown by a huge number of clinical studies.

Again, an important point that Fleming also spoke about – when using antibacterial drugs, it is very important to follow the dosage, the time between doses.

It is important that the appropriate concentration of the antibiotic is maintained in the blood. If the drug should be taken every 8 hours, but we missed one dose, what happens? The concentration of the antibacterial drug in the blood decreases. And here the bacteria – “hooray”, begin to multiply quickly, because the concentration does not kill them. Some may die, but others multiply quickly – they also want to live.

Serhiy Dubrov: “when using antibacterial drugs, it is very important to follow the dosage and time between doses”

– How do modern antibiotics differ from the same penicillin?

– Modern antibiotics, to put it simply, are antibacterial drugs that contain certain substances in their structure that protect the structure of the antibiotic from being destroyed by bacterial enzymes that give bacteria resistance.

But, unfortunately, we have fewer and fewer new antibiotics every decade. If, for example, in the 80s of the last century, 16 new antibiotics were created, then by the end of 2022, only four new ones appeared, and in fact they are not very newsimply their chemical composition is more effective.

– There is also a well-established opinion that only antibiotic treatment is needed for tonsillitis and cystitis. Actually, that is why people choose them independently. Is it always like this?

– First of all, this is not always the case, because sore throat can be caused not always by bacteria, but also by viruses, just like cystitis. Therefore, you should consult a doctor and pass simple tests.

Again, if you have taken certain drugs in the past 3-6 months, your doctor may change the antibiotic group to avoid the risk of resistance. That is, in any case, you should consult a doctor, confirm the bacterial origin of the disease, and then take or not take antibiotics.

– That is, the widespread opinion that if I was prescribed an antibiotic last time, I can take it the next time, because it suits me, does it not work?

– This will most likely be a false opinion. But the question is in the period. If it was 15 years ago, you may be prescribed the same antibiotic. If it was not so long ago, 3-6 months ago, then there is a real possibility that the bacteria will be insensitive to the drug.

– That is, information about recently used antibiotics should be kept, but it is not about decades?

– Yes, it is several months.

Do you need to take probiotics after antibiotics?

– If you really want to support the farm business, then you should. This is, of course, a joke. One indication for the use of probiotics is antibiotic-associated diarrhea. Antibiotics can kill, in particular, the “normal” bacteria that live in the gut, which causes diarrhea. But only a doctor can diagnose such consequences and prescribe appropriate drugs. Otherwise, it is not necessary to take probiotics.

– Why can a person be allergic to antibiotics?

– If you compare different medicinal products, it is true that allergies to antibiotics are more common. Most often, on B-lactam antibiotics, on penicillins.

The patient should remember which drug he was allergic to and how it manifested itself. This is very important, because the subsequent administration of the same drug or drug from the same group can lead to much more serious consequences. It is important to inform the doctor or nurse about the allergy. Then you may be prescribed an antibacterial drug of another group.

– Has the situation with the uncontrolled use of antibiotics changed in Ukraine after the introduction of electronic prescriptions?

– The problem remains, but it is difficult to say how much it has changed, because resistance is growing quite rapidly. In hospital conditions, the resistance of bacteria exceeds 50% to more than three groups of antibiotics. These are catastrophic numbers.

Now our defenders, whom we send abroad for treatment, are simply isolated in European hospitalsbecause such bacterial flora, which is released from our wounded, is practically non-existent in Europe. I have already said that our resistance indicators are not the worst.

– What is the international experience of fighting this problem? Maybe there are specific cases that Ukraine is borrowing?

– We are developing a national strategy. There was a previous strategy that has already expired. We work closely with international partners on possible ways to solve the problem.

The main measures are the use of antibiotics only as indicated. This is the introduction of strict infection control measures, the lack of free access to antibacterial drugs and, very importantly, the restriction of the use of antibiotics in agriculture – both in crop and livestock production. It also has a huge impact on the spread of the resistance level.

Tens of thousands of tons of antibacterial drugs are used in the world every year precisely in agriculture. And here, too, control is needed. Currently, it hardly exists in Ukraine in the non-medical field.

Serhii Dubrov: “One indication for the use of probiotics is antibiotic-associated diarrhea”

– Why is antibiotic resistance even more dangerous during war?

– Logistic routes, principles of infection control are violated, the possibility of regular, permanent use of antibacterial drugs is violated. And the factor of any armed conflict, of course, including war, is by definition one of the factors of the spread of resistance.

– What is the connection between war and antibiotic resistance?

– Fighters on the battlefield are mostly infected with those bacteria that are sensitive to antibiotics.

– The Ministry of Health also issued a regulatory act this year, which provides for the use of simple antibiotics in combat injuries. Why? Because for the majority of injuries experienced, the use of first-generation cephalosporins is sufficient, if we are talking about injuries to the abdominal cavity, chest with damage to the esophagus, etc.

But those cases, when from the start they begin to treat the injured with three or four antibacterial drugs, when there is no possibility that the wound is contaminated with resistant or polyresistant pathogens, precisely lead to the appearance of resistant bacteria.

– You have already mentioned several infections that are practically not treated with antibiotics. What other bacteria are difficult to treat?

– The most problematic pathogens are Acinetobacter baumania, Klebsiella pneumonia, Escherichia coli and Pseudomonas aeruginosa. They have the highest level of resistance not only in Ukraine, but also in the whole world. These bacteria can cause a whole range of diseases: from intestinal and urological infections to inflammation of wounds and purulent processes in the body.

Pneumococcus, the main causative agent of pneumonia, already has 10%-25% resistance even in European countries to synthetic penicillins, which was not the case 5 years ago.

– Are there environments where they are most likely to be caught?

– Most often, this is an intensive care unit. But today they can also be picked up outside the hospital.

The recommendations for preventing infections and the growth of antimicrobial resistance are very simple and familiar to everyone: maintaining hygiene, constantly monitoring one’s own health and taking medicines only after talking to a doctor. If the patient has already been prescribed antibiotics, it is necessary to adhere to the administration schedule and not stop taking them until the end of the course.

Already in 2050, antibiotic resistance may take up to 10 million lives every yearin. This means that we can see our grandchildren die of pneumonia.

Living in the post-antibiotic era means that we will have to forget about many medical advances, because without antibiotics, even the simplest operations will once again become deadly. This cannot be allowed.

Kateryna Dorosh (Khoroshchak), UP. Life

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