CC BY
30elSSN 2409 - 6334
INTERVIEWS
Meet an Expert: Elmira M. Satbayeva and Aida M.
Seytaliyeva
«Combating Antibiotic Resistance...»
Today we are going to take from you an interview about antibiotics-irreplaceable resource of mankind.
How do you think, there is a problem of microbial resistance to antibiotics, so it is relevant for all countries, including Europe, despite the fact that antibiotics are used by prescription. Why is it so?
Currently, the problem of antibiotic resistance has become so prevalent that in 2014 WHO published a report dealing with this issue. The problem of resistance of microbes has always existed. Its occurrence is due to natural mutations and to the ability of microorganisms transfer resistance factors (plasmids or slot of gene) to each other. In past decades, antibiotics were used widely, new drugs were provided and people thought that this will continue. However, at the present time, resistance began to grow so fast that pharmaceutical companies became not profitable to issue new substances. The usage of antibacterial drugs has been under control in Europe, but the process of globalization and the accompanying migration of the population leads to a
Elmira M. Satbayeva is a Head of the Department of Pharmacology at Asfendiyarov Kazakh National Medical University. She has been involved in research projects such as: «Access to drugs in the framework of globalization», «Development of nanoencapsulated form of effective antifungal agents controlled release and prolonged action», «Scientific and methodical support of the formation and development of translational medicine», «New strains of bacteria, promising to create drugs to prevent and treat tinea» and etc.
Elmira M. Satbayeva has about 100 scientific publications, including peer-reviewed journals with impact factor. She has a patent and an inventor's certificate.
She became an expert of the Republican Center for Health Development on the development of clinical protocols; an expert of the National Testing Center; a member of the local ethics committee of KazNMU; internal auditor of quality management system of the University; a member of the Scientific Committee on Problems of Pharmacy and Pharmacology; a member of «General Medicine Faculty» at KazNMU.
constant emergence of new resistant strains.
In recent years, there is a huge debate on the possibility of short treatment of various infections including respiratory. How do you think, does reduction of the duration of treatment cause any changes in the final therapeutic efficacy and the spread of drug-resistant pathogens?
Antibacterial drugs according to their pharmacokinetic parameters can be divided into 3 groups:
a) those for which the increase in the concentration
of drug in the blood did not increase bactericidal effect (time-dependent killing), their effect depends only on the time of maintaining the minimum inhibitory concentration in blood, these include for example Penicillins and Cephalosporins;
b) those in which the pharmacological effect is directly linked to the concentration of antibiotics in the blood (concentration-dependent
killing), for example the Aminoglycosides;
C) those whose effect depends on overall impact on the organism (AUC-dependent killing), there are Azithromycin, Clindamycin, Tetracycline, etc. In this regard, application of, in particular, drugs of the
http://isjm.kaznmu.kz/ 12
ISJM | VOLUME 1 | No 4 | 2015
INTERVIEWS
second group can really quickly lead to suppression of infection without increasing the risk of resistance development, however, it need to create in the blood a very high concentration of the drug, not all patients can tolerate this treatment. In any case, treatment should be individualized. The main requirement is to make sure that the infection is completely destroyed.
Picture 1. A seminar on the topic: “Rules for writing prescriptions44
How the national guidelines on antibiotic therapy are related with the European ones? Is it because of antibiotic resistance in Europe countries is much lower than in Kazakhstan?
In general, national recommendations on antibiotic therapy coincide with the European, because the problem and its solution are the same. However, the problem is that in our country they are often not respected. For example, we still going on vacation over-the-counter antibiotics, many patients are engaged in selftreatment, bacterial sensitivity tests are often not done and treatment is performed empirically. In addition, clinical protocols for treatment may include treatment by drugs that already have developed resistance. In developed countries there are centers for monitoring and control of antibiotic resistance, in Russian Federation, for example. In our Republic such specialized center is not exist. However, works in this direction are underway. For example, this year in Almaty on the 20th of November, a seminar was held for the employees of the sanitary-epidemiological services, they were dealing with the problem of antibiotic resistance and ways to combat further spread of resistant organisms.
How to change data on the prevalence of drug-resistant pathogens, and what are the trends in
13 http://isjm.kaznmu.kz/
choice of the therapy?
Today, the choice of drug should take into account following factors:
• Clinical efficacy of the drug;
• The level of resistance of pathogens in the population ;
• The ability of the antibiotic to provide “collateral damage”;
• Range of adverse reactions;
• Cost.
Collateral damage is the effect of antibiotics leading to selection of drug-resistant organisms, unwanted development of colonization or infection with multiple resistance. However, in reality, the greatest role is played by the cost of drugs.
What makes you contribute to the problem of antibiotic resistance and antibiotic use in food industry (vegetables, meat and dairy products)?
Use of antimicrobial drugs in food industry and agriculture is an inevitable process, without this it is impossible to treat animals and ensure a long storage of food and feed. However, it should be rigorously controlled. Unfortunately, the abuse of antibiotics in these sectors leads to the emergence of more resistant strains of microorganisms.
What is the role and place of modern Macrolides, respiratory Fluoroquinolones in the treatment of bacterial infections?
When the Macrolides and Fuoroquinolones appeared first they affected virtually on all pathogenic bacteria, however the level of resistance to them is so high that many doctors just stopped to use them. However we should not forget about them, there have been cases when the use of Fluoroquinolones has saved the lives of seemingly hopeless patients.
What are the most common errors that can be noted in the treatment of antibacterial drugs?
Firstly, it is the prescribing drugs without taking into account the sensitivity to AB. Secondly, it is a waste treatment scheme - i.e. wrong dose, frequency, duration of treatment, combined medication, without con-
2015 | No 4 | VOLUME 1 | ISJM
INTERVIEWS
sidering their interaction, etc. Thirdly, this failure of compliance, i.e. treatment adherence by patients. This means patients violate a medical prescriptions. And the most important is uncontrolled use of antibiotics by patients, self-treatment.
Interviewers: Gulder Nurzhankyzy Alfiya Sabit
ISJM | VOLUME 1 | No 4 | 2015
http://isjm.kaznmu.kz/ 14
