Comparative assessment of antibacterial drugs used at the hos-pital level before and during COVID-19, according to the WHO AWaRe classification

Comparative assessment of antibacterial drugs used at the hos-pital level before and during COVID-19, according to the WHO AWaRe classification | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative assessment of antibacterial drugs used at the hos-pital level before and during COVID-19, according to the WHO AWaRe classification Aigerim Balapasheva, Liliya Ziganshina, Aigul Mussina, Gaziza Smagulova, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4909317/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract Background This study presents a comprehensive analysis of antibiotic consumption in a dispensary hospital in Aktobe, Kazakhstan, from 2019 to 2021, utilizing the World Health Organization's (WHO) "Access, Watch, and Reserve" (AWaRe) classification. Objective The primary objective of this study was to assess the patterns of antibiotic use in the hospital and to determine the extent to which the AWaRe classification could be effectively implemented in Kazakhstan to guide optimal antibiotic use and establish performance targets. Methods The study analyzed data on the consumption of systemic antibacterial drugs in the dispensary hospital from 2019 to 2021. The usage of antibiotics was classified according to the WHO's AWaRe classification, which categorizes antibiotics into three groups: "Access," "Watch," and "Reserve." Results The study revealed a concerning trend in the irrational consumption of systemic antibiotics. There was a notable decrease in the use of "Access" antibiotics from 39.13% in 2019 to 22% in 2021, which is contrary to WHO recommendations. Conversely, the use of "Watch" antibiotics increased, particularly during the COVID-19 pandemic. The most commonly used antibiotics were cephalosporins, fluoroquinolones, and carbapenems. Conclusion The findings underscore the urgent need for implementing the AWaRe classification database in Kazakhstan to guide optimal antibiotic use, set performance targets, and establish a working group to monitor and control the prescription and use of antibacterial drugs. This study contributes to the global understanding of antibiotic consumption patterns and the challenges faced in adhering to international guidelines, particularly in the context of a pandemic. antibacterial drugs antibiotic consumption AwaRe World Health Organization antibiotics COVID-19 Figures Figure 1 Figure 2 Introduction As we know, antibiotic resistance is a global health problem with huge social and economic costs. According to the World Health Organization (WHO), the share of drug costs in national health budgets varies from 40 to 70% [ 1 ]. Improving the use of antibiotics in hospitals is one of the main goals of the World Health Organization's (WHO) Global Action Plan to Combat Antibiotic Resistance. Due to the shortage of new antibiotics and the withdrawal of some large pharmaceutical companies from the field of antibacterial drugs, WHO recently issued a new warning regarding the global threat of SCP and calls on all countries to find a balance between ensuring access to vital antibiotics and slowing drug resistance [ 2 ]. Kazakhstan, as part of the global community, adheres to WHO recommendations. However, despite a slight decrease in the consumption of systemic antibacterial drugs in recent years, the irrational use of antibiotics continues to persist in Kazakhstan. This is due to the fact that 27.5% of antibiotics are taken by patients without a doctor's ap-pointment and with excessive prescribing (the proportion of prescribed antibiotics is 29.9% of all drugs, which exceeds the WHO recommended level of 20%) [ 3 ]. In addition, the current global situation with the COVID-19 pandemic in 2020 has again shown the relevance of the existing problem of irrational use of medicines, namely the unjustified use of antibiotics in Kazakhstan, as well as the lack of epidemiological surveillance and monitoring of antibiotic resistance in medical institutions of the Republic of Kazakhstan [ 4 ]. A review of studies of hospitalized COVID–19 patients from other countries showed that of 72% of patients receiving antibiotics, only 8% have concomitant bacterial or fungal infections. Experts said that we are close to the era of the lack of effective antibiotics, as the problem of resistance to antibacterial drugs reaches a peak [ 5 , 6 , 7 ]. Recent reports also indicate that some microorganisms have developed resistance to carbapenems, antibiotics that are often used as a last resort in the treatment of K. pneumonia infection [ 8 ]. To optimize the rational use of antibiotics and support the monitoring of antibiotic resistance, the World Health Organization (WHO) has classified antibacterial drugs into the "Access", "Watch" and "Reserve" groups, the well-known "AWaRe" classification, which also lists antibiotics not recommended by WHO, especially combinations with fixed doses of several broad-spectrum antibiotics for which there is no proven evidence. AWaRe is a useful tool for monitoring antibiotic consumption developed by WHO "to help countries improve antibiotic treatment, expand access and reduce resistance." The AWaRe Antibiotic Classification was developed in 2017 by the WHO Committee of Experts on the Selection and Use of Essential Medicines as a tool to support efforts for the rational use of antibiotics at the local, national and global levels [ 8 ]. The main goal of WHO was that in 2023, at least 60% of the total antibiotic use at the country level was accounted for by the access group in order to curb the growth of resistance and make the use of antibiotics safer and more effective [ 9 ]. However, achieving this goal has been difficult due to the COVID-19 pandemic, and recent data have shown that resistance to antibacterial drugs increased after 2019–2020 (e.g. resistance to carbapenems and polymyxins) [ 10 , 11 ]. Thus, the study of the consumption of antibacterial drugs in medical institutions in the country allows us to assess the real picture and develop effective measures to suppress antibiotic resistance. The purpose of our study is to conduct a comparative analysis of the consumption of antibacterial drugs for systemic use in the Aktobe dispensary hospital for 2019–2021 with the classification "Access", "Watch" and "Reserve" (AWaRe) The World Health Organization (WHO). In the main task of our research, we substantiate the need to introduce the WHO AWaRe classification database in the Republic of Kazakhstan as a tool for managing the effective use of antibiotics and setting performance indicators. Methods A retrospective and descriptive study conducted using data from the movement of medicines in the organization for the period 2019–2021 consumption of all antibiotics (J01) in a dispensary hospital in Aktobe. We measured the proportion of antibiotic use in each category and calculated the ratio of antibiotics for each year according to the WHO AWaRe tool. We also used the anatomical, therapeutic and chemical classification developed by WHO to prioritize the consumption of pharmacological classes of antibiotics. The consumption of antibiotics was classified into categories: available, observational, reserve: "Access" antibiotics have a narrow spectrum of action, lower cost, good safety profile and, as a rule, low resistance potential. They are often recommended as an empirical first- or second-choice treatment option for common infections. "Watch" antibiotics are broader-spectrum antibiotics, usually have a higher cost and are recommended only as first-choice options for patients with more severe clinical manifestations or for infections in which pathogens are more likely to be resistant to antibiotics. "Reserve" are the last choice antibiotics used to treat multidrug-resistant infections. The Access group includes 48 antibiotics, 19 of which are included in the WHO OLS List as options for the empirical treatment of the first or second variants of certain infectious syndromes, the observation group includes 110 antibiotics, 11 of which are included in the WHO OLS List as the first or second options for the empirical treatment of certain infectious syndromes, and the reserve The group includes 22 antibiotics. Seven antibiotics of the reserve group are listed in the WHO OLS List. Traffic light color codes have been proposed to indicate different categories: antibiotics "Access" (green), antibiotics "Watch" (yellow) and antibiotics "Reserve" (red). This tool can be adopted by clinicians to monitor antibiotic use and implement surveillance measures at the local level, as well as to develop recommendations for antibiotic treatment. Results According to the AWaRe classification, the general access category includes anti-bacterial drugs of the first and second choice for the empirical treatment of bacterial infections, which implies wide access to them in healthcare organizations. This group includes antibiotics that have activity against a wide range of commonly occurring sensitive pathogens, and also demonstrate a lower resistance potential than antibiotics from other groups. According to the results of our study, only 23 antibacterial drugs were used before the pandemic in 2019. The models used were described in accordance with the WHO AWaRe classification of antibiotics, in which antibiotics were divided into three groups: "Access", "Watch", "Reserve". The "Access" group included 9 antibacterial drugs, and 14 antibacterial drugs from the total number of antibiotics were identified for the "Watch" group. 18 of them are included in the WHO list of essential medicines and 5 are not recommended antibiotics. There were no antibiotics of the "Reserve" group. A description of the complete classification of antibiotics is presented in Table 1 . Table 1 List of J01 antibiotics consumed in 2019, according to the WHO AWaRe classification № ATC code Antibiotic Class Category Belonging to the List of essential medicines 1 J01FA10 Azithromycin Macrolides Watch Yes 2 J01CA01 Ampicillin Penicillins Access Yes 3 J01CЕ01 Benzylpenicillin Penicillins Access Yes 4 J01GB03 Gentamicin Aminoglycosides Access Yes 5 J01CA04 Amoxicillin Penicillins Access Yes 6 J01DD04 Ceftriaxone Third generation cephalosporins Watch Yes 7 J01DB04 Cefazolin First generation cephalosporins Watch Yes 8 J01GB06 Amikacin Aminoglycosides Access Yes 9 J01CR02 Amoxicillin/Clavulanic acid Beta-lactam is a beta-lactamase inhibitor. Access Yes 10 J01XA01 Vancomycin Glycopeptides Watch Yes 11 J01AA02 Doxycycline Tetracyclines Access Yes 12 J01DH04 Doripenem Carbapenems Watch No 13 J01FA09 Clarithromycin Macrolides Watch Yes 14 J01MA12 Levofloxacin Fluoroquinolones Watch No 15 J01DH02 Meropenem Carbapenems Watch Yes 16 J01MA01 Ofloxacin Fluoroquinolones Watch No 17 J01BA02 Thiamphenicol Amphenicols Access No 18 J01DC02 Cefuroxime Second generation cephalosporins Watch Yes 19 J01DD02 Ceftazidime Third generation cephalosporins Watch Yes 20 J01DD01 Cefotaxime Third generation cephalosporins Watch Yes 21 J01DE01 Cefepime Fourth generation cephalosporins Watch Yes 22 J01FA01 Erythromycin Macrolides Watch No 23 J01XD01 Metronidazole Imidazoles Access Yes Compared to 2019, in 2020 we saw an increase in the number of antibiotics used during the pandemic. That is, in 2020, twenty-seven antibacterial drugs were used, ac-cording to the WHO AWaRe classification, 7 were in the "Access" group, 19 were in the "Watch" group, and none were identified in the "Reserve" group. 16 are included in the WHO list of essential medicines, and 10 are not included in the WHO list of essential medicines. Table 2 List of J01 antibiotics consumed in 2020, according to the WHO AWaRe classification № ATC code Antibiotic Class Category Belonging to the List of essential medicines 1 J01FA10 Azithromycin Macrolides Watch Yes 2 J01MA01 Ofloxacin Fluoroquinolones Watch No 3 J01MA02 Ciprofloxacin Fluoroquinolones Watch Yes 4 J01XA01 Vancomycin Glycopeptides Watch Yes 5 J01MA12 Levofloxacin Fluoroquinolones Watch No 6 J01DD01 Cefotaxime Third generation cephalosporins Watch Yes 7 J01DD04 Ceftriaxone Third generation cephalosporins Watch Yes 8 J01C R05 Piperacillin-Tazobactam Combinations of penicillins, including with inhibitors & beta -lactamases Watch Yes 9 J01FF02 Lincomycin Lincosamides Watch No 10 J01CA04 Amoxicillin Penicillins Access Yes 11 J01CR02 Amoxicillin/Clavulanic acid Beta-lactam is a beta-lactamase inhibitor. Access Yes 12 J01GB06 Amikacin Aminoglycosides Access Yes 13 J01CA01 Ampicillin Penicillins Access Yes 14 J01GB03 Gentamicin Aminoglycosides Access Yes 15 J01DH04 Doripenem Carbapenems Watch No 16 J01DH51 Imipenem + Cilastatin Carbapenems Watch No 17 J01FA09 Clarithromycin Macrolides Watch Yes 18 J01DC02 Cefuroxime Second generation cephalosporins Watch Yes 19 J01DH02 Meropenem Carbapenems Watch Yes 20 J01XD01 Metronidazole Imidazoles Access Yes 21 J01M A14 Moxifloxacin Fluoroquinolones Watch No 22 J01DB04 Cefazolin First generation cephalosporins Watch Yes 23 J01FA01 Erythromycin Macrolides Watch No 24 J01DH03 Ertapenem Carbapenems Watch No 25 J01BA02 Thiamphenicol Amphenicols Access No 26 J01DE01 Cefepime Fourth generation cephalosporins Watch No Comparing the results of 2021 with 2020, it is clear that the number of antibiotics used has decreased. That is, seventeen antibiotics were used in 2021. Of these, 5 were included in the "Access" group, 12 in the "Watch" group, and none in the "Reserve" group. 13-the antibiotic is included in the WHO OLS List, and 4 - are not included in the WHO OLS List. Table 3 List of J01 antibiotics consumed in 2021, according to the WHO AWaRe classification № ATC code Antibiotic Class Category Belonging to the List of essential medicines 1 J01СR02 Amoxicillin sodium and potassium clavulanate Beta-lactam is a beta-lactamase inhibitor. Access Yes 2 J01GB06 Amikacin Aminoglycosides Access Yes 3 J01CA01 Ampicillin Penicillins Access Yes 4 J01XA01 Vancomycin Glycopeptides Watch Yes 5 J01GB03 Gentamicin Aminoglycosides Access Yes 6 J01DH04 Doripenem Carbapenems Watch No 7 J01FA10 Azithromycin Macrolides Watch Yes 8 J01DH51 Imipenem + Cilastatin Carbapenems Watch No 9 J01MA12 Levofloxacin Fluoroquinolones Watch No 10 J01XD01 Metronidazole Imidazoles Access Yes 11 J01DH02 Meropenem Carbapenems Watch Yes 12 J01MA01 Ofloxacin Fluoroquinolones Watch No 13 J01DD04 Ceftriaxone Third generation cephalosporins Watch Yes 14 J01DE01 Cefepime Fourth generation cephalosporins Watch Yes 15 J01DB04 Cefazolin First generation cephalosporins Watch Yes 16 J01DD01 Cefotaxime Third generation cephalosporins Watch Yes 17 J01DC02 Cefuroxime Second generation cephalosporins Watch Yes A comparative analysis of the consumption of antibiotics for systemic use in 2019–2021 shows that the level of antibiotic use in the Access group decreased from 39.13% in 2019 to 28% in 2020, and 22% in 2021. Thus, in the Aktobe dispensary hospital, there is a decrease in the consumption of antibiotics of the "Access" group. There is an increase in the consumption of antibiotics of the "Watch" group. That is, we noticed that in 2019 the "Watch" level was 60.87%, and in 2020 the level increased to 72%. The results of the comparison are presented in Fig. 1.2. Using a chi-squared test, the proportions of antibiotics in the "Access" and "Watch" categories were compared between different years. Chi-square test results Chi-squared value: 5.77 p-value: 0.056 Degrees of freedom: 2 Expected frequencies: Access: [30.38, 30.38, 28.25] Watch: [69.62, 69.62, 64.75] A Chi-squared value of 5.77 indicates differences between observed and expected values, but not very high. The p-value (0.056) is close to the usual threshold of statistical significance (0.05). This means that although there is some evidence of changes in antibiotic consumption over the years, these changes are not significant enough to reject the null hypothesis of consumption stability over time. Based on the analysis, it can be concluded that although there are some changes in the consumption of antibiotics of the "Access" and "Watch" categories in the period from 2019 to 2021, these changes are not statistically significant. This indicates a relative stability in the consumption of antibiotics of these categories during the study period. And we also saw that the growth in the consumption of antibiotics at the "Watch" level remained unchanged by the results of 2021. To understand how often "Watch" antibiotics are used in Aktobe, we looked at the most consumed antibiotics. It should be noted that according to the results of 2020, we see that the most com-monly used antibiotics were of the cephalosporin group. In addition, we noticed that relatively in 2020, antibiotics from the "Watch" group ciprofloxacin, piperacillin-tazobactam, as well as antibiotics ertapenem, moxifloxacin, imipenem + cilastatin and lincomycin were often used during the pandemic, even if they were not included in the list of WHO essential medicines. These antibiotics were not used in 2019 before the pandemic. Discussion As mentioned above, in general, during the period under review, we revealed a negative trend in the consumption of systemic antibiotics in all three categories of the WHO AWaRe classification. In the analysis of our study of the total consumption of antibiotics in accordance with WHO recommendations, a systematic decrease in the consumption of antibiotics was shown during the study period. That is, in the analysis of 2019 before the pandemic, the Access group showed a figure of 39%, in 2020 during the pandemic it was 28%, and in 2021 it decreased to 22%. The WHO AWaRe classification states that the consumption of antibiotics from the "Access" group should be at least 60%. On the contrary, more than half of the prescribed antibiotics in the Aktobe dispensary hospital were from the "Watch" group. During the study period, we found such a negative trend that the share of antibiotics consumed by the "Watch" group increased from 60.87% in 2019 to 71% in 2020–2021. Aktobe is the western part of Kazakhstan, which accounts for 11% of the total area of the territory of Kazakhstan. The medical institution in which we conducted the study is one of the largest multidisciplinary medical centers in Aktobe, consisting of a surgical profile, a therapeutic profile, paraclinical units and a maternity service. Coronavirus infection was detected in our country in March 2020. Since that moment, on the basis of the order of the regional health department of the Aktobe region No. 68 − 5 dated April 16, 2020, the multidisciplinary hospital has been redesignated into a dispensary hospital. Since 2020, 2,223 patients with severe pneumonia in combination with various concomitant diseases COVID-19 have received inpatient treatment at the multidisciplinary dispensary hospital. A study on antibiotic prescribing in India also revealed a similar practice: 46.80% of antibiotics from the "Access" group were prescribed a category, antibiotics from the observation group accounted for 53.19% of the total number of prescribed antibiotics [ 12 ]. In general, the consumption of antibacterial drugs corresponded to the hospital formulary and was prescribed under their nonproprietary names. According to standard treatment recommendations, antibacterial drugs were also prescribed to patients with pneumonia. In our study, third-generation cephalosporin antibiotics from the observation group were most often prescribed. Atif [ 12 ] and others in the Republic of the Congo study reported that the most commonly prescribed drug was ceftriaxone from the third generation cephalosporin injection, which belongs to the observation category, which accounted for 31.1% [ 12 ] According to our research, we can see a similar result in the studies of other col-leagues in our country. That is, a comparative analysis of the consumption of antibiotics for systemic use in 2017–2019 shows a decrease in the consumption of drugs of the Access group, and there is also an increase in the consumption of antibiotics of the Watch group. Thus, in Kazakhstan, there is a decrease in the consumption of antibiotics of the "Access" group from 39–30% for the period 2017–2019 [ 13 ]. For comparison with the study of England, the share of consumption of antibiotics of the "Access" group in 2016 was 60.9%, and "Watch" -37.9% [ 14 ]. Let's also say that in Kazakhstan there is no state registration of antibiotics from the "Access" group – cloxacillin, phenoxymethylpenicillin, spectinomycin and from the "Reserve" group – ceftazidim + avibactam, meropenem + vabrobactam, plasomycin, polymyxin B. This undoubtedly limits the physical availability of key antibiotics, this is especially important for the "Reserve" group due to their use in life-threatening conditions associated with antibiotic resistance. There is also no registration of a number of medicinal forms of antibiotics from all groups of antibiotics according to the AWaRe classification. These are mainly oral liquid dosage forms and dosage forms for children. Some dosage forms of release and dosage of amoxicillin, chloramphenicol, clindamycin, doxacycline, metronidazole, nitrofurantoin have not been registered in the Access group in Kazakhstan. Some dosage forms of cefotaxime, piperacillin + tazobactam, and vancomycin ceftazidime have not been registered in the Watch group in Kazakhstan. Injectable fosfomycin and oral linezolid solution were not registered in the Reserve group. Due to the lack of registration in Kazakhstan of a number of antibiotics and dosage forms (mainly liquid and children's), it is necessary to develop a state strategy to ensure their accessibility for practical healthcare and improve the quality of medical care [ 15 ]. The Association of our country "Professional Association of Clinical Pharmacolo-gists and Pharmacists", created by all clinical pharmacologists of medical institutions in Kazakhstan, works at a high level with the aim of rational use of medicines. But despite the great work done to inform the population and medical workers, the problem of irrational consumption of antibiotics remains a serious problem for the Health Organization of Kazakhstan. We believe that one of the main reasons for the inappropriate use of antibiotics in Kazakhstan is the lack of clinical pharmacologists in the country's medical institutions responsible for achieving the effectiveness and safety of pharmacotherapy. In our previous pharmacoepidemiological study of antibacterial therapy in this hospital, it was revealed that the consumption of antibacterial drugs during the pan-demic period increased sharply compared with the pre-pandemic period, that is, the most noticeable increase in consumption was observed in the group of third-generation cephalosporins. In particular, ceftriaxone ranked first with the level of antibiotic consumption [ 16 ]. A similar situation in a large hospital, Almaty, Kazakhstan, 2020–2021. most of the treatment methods did not meet national recommendations, including 98% of the use of anticoagulants, 95% of the use of antibiotics, 56% of the use of glucocorticoids and 56% of the use of antiviral drugs during the COVID-19 pandemic, respectively, cephalosporin antibiotics turned out to be the most commonly prescribed antibacterial drugs [ 17 ]. In the updated 2021 AWaRe classification, 257 antibiotics used worldwide were assigned to the AWaRe groups (including all 39 antibiotics included in the WHO 2021 Indicative List of Essential Medicines and 36 antibiotics in the WHO Model List of Essential Medicines for Children). The 2021 standard lists include 31 Access and Watch antibiotics (about 6% of the 479 drugs in the standard lists) [ 18 – 20 ]. In a meta-analysis, researchers assessed the risk of colonization or infection with multidrug-resistant pathogens after exposure to antibiotics classified into AWaRe categories [ 21 ]. For comparison, in one systematic evaluation study, antibiotics used in 76 countries between 2000 and 2015 were classified into "Access", "Watch" and "Reserve" categories. This study showed that global antibiotic consumption increased by 90.9% in "Watch" antibiotics and by 26.2% in "Access" antibiotics between 2000 and 2015. The significant increase in the proportion of antibiotic "Watch" consumption was mainly caused by low- and middle-income countries, which increased by 165% compared with 27.9% in high-income countries. The rapid growth in the consumption of "Watch" antibiotics, especially in low- and middle-income countries, reflects problems in the rational use of antibiotics [ 22 ]. In addition, market analysis of antibacterial drugs sold in Pakistan, among which there are an excessive number of brands, belong to the "Watch" AWaRe category. The more brands there are, the higher the marketing pressure on doctors prescribing medicines will be [ 23 , 24 ]. Conclusion and Relevance The results of the study showed an alarming picture of the irrational consumption of systemic antibiotics in the Aktobe dispensary hospital. It was found that during the study period, the consumption of Access antibiotics decreased from 39.13–72%. It was revealed that antibiotics of the "Watch" group were widely used during the pandemic in Aktobe. Antibiotics from the group of cephalosporins, fluoroquinolones, and carbapenems were often used in the "Watch" group. In general, the consumption of parenteral forms of systemic antibiotics prevails in the Aktobe dispensary hospital. In conclusion, our study highlights the need to implement the database of the AWaRe classification recommended by the World Health Organization in Aktobe as a tool to support setting performance targets and guide optimal use of antibiotics. To evaluate and monitor the use of antibiotics by creating and functioning a working group to control the validity of the use and prescription of antibacterial drugs in a medical organization in the Republic of Kazakhstan. Abbreviations COVID-19 Coronavirus infectious disease 2019 WHO World Health Organization's AWaRe "Access, Watch, and Reserve" Declarations Acknowledgements We express our gratitude to the management of the 'Aktobe Medical Center' and the clinical pharmacologist of the medical center for providing the data for the study. Author Contributions Conceptualization, A.A.B., G.A.S., A.Z.M., M.S.K. and L.E.Z.; methodolo-gy, A.A.B.; software, A.A.B., B.L.S.; validation, A.A.B.; formal analysis, A.A.B., L.E.Z.; investiga-tion, A.A.B.; resources, G.A.S., A.Z.M.; data curation, A.A.B., G.A.S., A.Z.M.; writing—original draft preparation, A.A.B.; writing—review and editing, G.A.S., A.Z.M., M.S.K., L.E.Z.; visualiza-tion, L.E.Z.; supervision, G.A.S., A.Z.M., L.E.Z.; project administration, G.A.S., A.Z.M.; funding acquisition, B.L.S. All authors have read and agreed to the published version of the manuscript. Funding None. Availability of data and materials Data are partially included in this manuscript as quotes from survey responses; the complete survey answers are not made public for anonymity reasons. Consent for publication All authors have given consent for submission and potential publication of this manuscript. Competing interests None declared by all author Author details 1 Department of Pharmacology, Clinical pharmacology, Department of Otorhinolaryngology, Ophthalmology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan 2 Russian Medical Academy of Continuous Professional Education, Moscow, Russia 3 Department of General and Clinical Pharmacology, Рeoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University named after Patrice Lumumba), Moscow, Russia 4 Department of Pharmacology, Kazan State Medical University, Kazan, Russia 5 Aktobe Medical Center, Aktobe, Kazakhstan References th meeting report of WHO advisory group on integrated surveillance of antimicrobial resistance (AGISAR). Geneva: World Health Organization; 2018. Available from: https://apps.who.int/iris/bitstream/handle/1 0665/272714/WHO-NMH-FOS-FZD-18.1- eng.pdf The State of the World's Antibiotics 2021. A Global Analysis of Antimicrobial Resistance and Its Drivers. 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Assessment of WHO antibiotic consumption and access targets in 76 countries, 2000-15: an analysis of pharmaceutical sales data. Lancet Infect Dis. (1), 107–115. 10.1016/S1473-3099(20)30332-7 [PubMed] [CrossRef] [Google Scholar] Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editor assigned by journal 18 Aug, 2024 Submission checks completed at journal 14 Aug, 2024 First submitted to journal 13 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4909317","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":341698115,"identity":"80ec4a8a-a09c-49ca-aded-34ccb4e6bf80","order_by":0,"name":"Aigerim Balapasheva","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYFACHgaGByBaAkRUMBgASWbCWhLgWs6QrIWxjQgt/A28Bz8k1NyRl5/dfEzi57w6Y90ZCcyGP/BokTjAlyyRcOyZ4YY7x9Ike7exmZndSGBOkMBnzQEeA4kEtsOMGyRyjA14t/HYgLQcMMCjQ/4Aj/GPhH+H7efPyP9s+HeOBERLAh4tBgd4zCQS2w4nNtzIYXzM22AAcdgBPFoMD/OlWST2PUvecCPN8LHMsQRjszMPmw0b8GiRO957+MaHb3ds589IfnDwTU2d4bbjyYcl8YUYNA5QHMKIzw44wOf2UTAKRsEoGPEAABCZUhzJMggRAAAAAElFTkSuQmCC","orcid":"","institution":"West Kazakhstan Marat Ospanov State Medical University","correspondingAuthor":true,"prefix":"","firstName":"Aigerim","middleName":"","lastName":"Balapasheva","suffix":""},{"id":341698116,"identity":"940b5ac5-dfb7-4169-bb37-131d930d5e68","order_by":1,"name":"Liliya Ziganshina","email":"","orcid":"","institution":"Russian Medical Academy of Continuous Professional Education","correspondingAuthor":false,"prefix":"","firstName":"Liliya","middleName":"","lastName":"Ziganshina","suffix":""},{"id":341698117,"identity":"9eacc7c6-b4b8-4544-a565-e7cf408d01d6","order_by":2,"name":"Aigul Mussina","email":"","orcid":"","institution":"West Kazakhstan Marat Ospanov State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Aigul","middleName":"","lastName":"Mussina","suffix":""},{"id":341698118,"identity":"a660ba47-5247-4188-b615-cba9f4d9ff1c","order_by":3,"name":"Gaziza Smagulova","email":"","orcid":"","institution":"West Kazakhstan Marat Ospanov State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Gaziza","middleName":"","lastName":"Smagulova","suffix":""},{"id":341698119,"identity":"e36b7420-c57c-4833-9553-e19d891bd6c5","order_by":4,"name":"Mariya Kulnazarova","email":"","orcid":"","institution":"Aktobe medical center","correspondingAuthor":false,"prefix":"","firstName":"Mariya","middleName":"","lastName":"Kulnazarova","suffix":""},{"id":341698120,"identity":"8df31c02-f1e7-4f37-a7f4-46a34bd823ce","order_by":5,"name":"Lazzat Balymbetova","email":"","orcid":"","institution":"West Kazakhstan Marat Ospanov State Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lazzat","middleName":"","lastName":"Balymbetova","suffix":""}],"badges":[],"createdAt":"2024-08-13 20:27:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4909317/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4909317/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64287713,"identity":"994e1a63-39b2-428b-a969-661a8ee1126d","added_by":"auto","created_at":"2024-09-11 09:03:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":10322,"visible":true,"origin":"","legend":"\u003cp\u003eComparative result of antibiotic consumption in Aktobe dispensary hospital, according to the AWaRe classification for 2019-2021.\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-4909317/v1/61b5f8ee11def748f60a19ea.png"},{"id":64287009,"identity":"45a63827-18b4-46a8-909f-f3bb055732c2","added_by":"auto","created_at":"2024-09-11 08:55:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":16044,"visible":true,"origin":"","legend":"\u003cp\u003eThe indicator of antibiotic consumption \"Access\", in the Aktobe dispensary hospital for 2019-2021\u003c/p\u003e","description":"","filename":"floatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-4909317/v1/e01eb0638f656d616d9324e7.png"},{"id":64288864,"identity":"289f1ad5-a620-4e81-8a8e-7e0eee34c951","added_by":"auto","created_at":"2024-09-11 09:11:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":706783,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4909317/v1/6d8ad217-4f6b-48cf-9ed9-cb71e0f50eff.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative assessment of antibacterial drugs used at the hos-pital level before and during COVID-19, according to the WHO AWaRe classification","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAs we know, antibiotic resistance is a global health problem with huge social and economic costs. According to the World Health Organization (WHO), the share of drug costs in national health budgets varies from 40 to 70% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Improving the use of antibiotics in hospitals is one of the main goals of the World Health Organization's (WHO) Global Action Plan to Combat Antibiotic Resistance. Due to the shortage of new antibiotics and the withdrawal of some large pharmaceutical companies from the field of antibacterial drugs, WHO recently issued a new warning regarding the global threat of SCP and calls on all countries to find a balance between ensuring access to vital antibiotics and slowing drug resistance [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eKazakhstan, as part of the global community, adheres to WHO recommendations. However, despite a slight decrease in the consumption of systemic antibacterial drugs in recent years, the irrational use of antibiotics continues to persist in Kazakhstan. This is due to the fact that 27.5% of antibiotics are taken by patients without a doctor's ap-pointment and with excessive prescribing (the proportion of prescribed antibiotics is 29.9% of all drugs, which exceeds the WHO recommended level of 20%) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, the current global situation with the COVID-19 pandemic in 2020 has again shown the relevance of the existing problem of irrational use of medicines, namely the unjustified use of antibiotics in Kazakhstan, as well as the lack of epidemiological surveillance and monitoring of antibiotic resistance in medical institutions of the Republic of Kazakhstan [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA review of studies of hospitalized COVID\u0026ndash;19 patients from other countries showed that of 72% of patients receiving antibiotics, only 8% have concomitant bacterial or fungal infections. Experts said that we are close to the era of the lack of effective antibiotics, as the problem of resistance to antibacterial drugs reaches a peak [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Recent reports also indicate that some microorganisms have developed resistance to carbapenems, antibiotics that are often used as a last resort in the treatment of K. pneumonia infection [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo optimize the rational use of antibiotics and support the monitoring of antibiotic resistance, the World Health Organization (WHO) has classified antibacterial drugs into the \"Access\", \"Watch\" and \"Reserve\" groups, the well-known \"AWaRe\" classification, which also lists antibiotics not recommended by WHO, especially combinations with fixed doses of several broad-spectrum antibiotics for which there is no proven evidence.\u003c/p\u003e \u003cp\u003eAWaRe is a useful tool for monitoring antibiotic consumption developed by WHO \"to help countries improve antibiotic treatment, expand access and reduce resistance.\" The AWaRe Antibiotic Classification was developed in 2017 by the WHO Committee of Experts on the Selection and Use of Essential Medicines as a tool to support efforts for the rational use of antibiotics at the local, national and global levels [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The main goal of WHO was that in 2023, at least 60% of the total antibiotic use at the country level was accounted for by the access group in order to curb the growth of resistance and make the use of antibiotics safer and more effective [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, achieving this goal has been difficult due to the COVID-19 pandemic, and recent data have shown that resistance to antibacterial drugs increased after 2019\u0026ndash;2020 (e.g. resistance to carbapenems and polymyxins) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Thus, the study of the consumption of antibacterial drugs in medical institutions in the country allows us to assess the real picture and develop effective measures to suppress antibiotic resistance.\u003c/p\u003e \u003cp\u003eThe purpose of our study is to conduct a comparative analysis of the consumption of antibacterial drugs for systemic use in the Aktobe dispensary hospital for 2019\u0026ndash;2021 with the classification \"Access\", \"Watch\" and \"Reserve\" (AWaRe) The World Health Organization (WHO). In the main task of our research, we substantiate the need to introduce the WHO AWaRe classification database in the Republic of Kazakhstan as a tool for managing the effective use of antibiotics and setting performance indicators.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA retrospective and descriptive study conducted using data from the movement of medicines in the organization for the period 2019\u0026ndash;2021 consumption of all antibiotics (J01) in a dispensary hospital in Aktobe. We measured the proportion of antibiotic use in each category and calculated the ratio of antibiotics for each year according to the WHO AWaRe tool. We also used the anatomical, therapeutic and chemical classification developed by WHO to prioritize the consumption of pharmacological classes of antibiotics. The consumption of antibiotics was classified into categories: available, observational, reserve:\u003c/p\u003e \u003cp\u003e\"Access\" antibiotics have a narrow spectrum of action, lower cost, good safety profile and, as a rule, low resistance potential. They are often recommended as an empirical first- or second-choice treatment option for common infections.\u003c/p\u003e \u003cp\u003e\"Watch\" antibiotics are broader-spectrum antibiotics, usually have a higher cost and are recommended only as first-choice options for patients with more severe clinical manifestations or for infections in which pathogens are more likely to be resistant to antibiotics.\u003c/p\u003e \u003cp\u003e\"Reserve\" are the last choice antibiotics used to treat multidrug-resistant infections.\u003c/p\u003e \u003cp\u003eThe Access group includes 48 antibiotics, 19 of which are included in the WHO OLS List as options for the empirical treatment of the first or second variants of certain infectious syndromes, the observation group includes 110 antibiotics, 11 of which are included in the WHO OLS List as the first or second options for the empirical treatment of certain infectious syndromes, and the reserve The group includes 22 antibiotics.\u003c/p\u003e \u003cp\u003eSeven antibiotics of the reserve group are listed in the WHO OLS List. Traffic light color codes have been proposed to indicate different categories: antibiotics \"Access\" (green), antibiotics \"Watch\" (yellow) and antibiotics \"Reserve\" (red). This tool can be adopted by clinicians to monitor antibiotic use and implement surveillance measures at the local level, as well as to develop recommendations for antibiotic treatment.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAccording to the AWaRe classification, the general access category includes anti-bacterial drugs of the first and second choice for the empirical treatment of bacterial infections, which implies wide access to them in healthcare organizations. This group includes antibiotics that have activity against a wide range of commonly occurring sensitive pathogens, and also demonstrate a lower resistance potential than antibiotics from other groups. According to the results of our study, only 23 antibacterial drugs were used before the pandemic in 2019. The models used were described in accordance with the WHO AWaRe classification of antibiotics, in which antibiotics were divided into three groups: \"Access\", \"Watch\", \"Reserve\". The \"Access\" group included 9 antibacterial drugs, and 14 antibacterial drugs from the total number of antibiotics were identified for the \"Watch\" group. 18 of them are included in the WHO list of essential medicines and 5 are not recommended antibiotics. There were no antibiotics of the \"Reserve\" group. A description of the complete classification of antibiotics is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eList of J01 antibiotics consumed in 2019, according to the WHO AWaRe classification\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e№\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eATC code\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAntibiotic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eClass\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBelonging to the List of essential medicines\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01FA10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAzithromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMacrolides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01CA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmpicillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePenicillins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01CЕ01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBenzylpenicillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePenicillins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01GB03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGentamicin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAminoglycosides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01CA04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmoxicillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePenicillins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DD04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCeftriaxone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThird generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DB04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCefazolin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFirst generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01GB06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmikacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAminoglycosides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01CR02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmoxicillin/Clavulanic acid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeta-lactam is a beta-lactamase inhibitor.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01XA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVancomycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGlycopeptides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01AA02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoxycycline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTetracyclines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DH04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoripenem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarbapenems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01FA09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClarithromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMacrolides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01MA12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLevofloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFluoroquinolones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DH02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeropenem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarbapenems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01MA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOfloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFluoroquinolones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01BA02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThiamphenicol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAmphenicols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DC02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCefuroxime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecond generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DD02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCeftazidime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThird generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DD01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCefotaxime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThird generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DE01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCefepime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFourth generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01FA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eErythromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMacrolides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01XD01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMetronidazole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImidazoles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCompared to 2019, in 2020 we saw an increase in the number of antibiotics used during the pandemic. That is, in 2020, twenty-seven antibacterial drugs were used, ac-cording to the WHO AWaRe classification, 7 were in the \"Access\" group, 19 were in the \"Watch\" group, and none were identified in the \"Reserve\" group. 16 are included in the WHO list of essential medicines, and 10 are not included in the WHO list of essential medicines.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eList of J01 antibiotics consumed in 2020, according to the WHO AWaRe classification\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e№\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eATC code\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAntibiotic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eClass\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBelonging to the List of essential medicines\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01FA10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAzithromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMacrolides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01MA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOfloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFluoroquinolones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01MA02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCiprofloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFluoroquinolones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01XA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVancomycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGlycopeptides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01MA12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLevofloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFluoroquinolones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DD01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCefotaxime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThird generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DD04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCeftriaxone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThird generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01C R05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePiperacillin-Tazobactam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCombinations of penicillins, including with inhibitors \u0026amp; beta -lactamases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01FF02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLincomycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLincosamides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01CA04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmoxicillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePenicillins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01CR02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmoxicillin/Clavulanic acid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeta-lactam is a beta-lactamase inhibitor.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01GB06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmikacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAminoglycosides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01CA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmpicillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePenicillins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01GB03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGentamicin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAminoglycosides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DH04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoripenem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarbapenems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DH51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImipenem\u0026thinsp;+\u0026thinsp;Cilastatin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarbapenems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01FA09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClarithromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMacrolides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DC02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCefuroxime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecond generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DH02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeropenem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarbapenems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01XD01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMetronidazole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImidazoles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01M A14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMoxifloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFluoroquinolones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DB04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCefazolin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFirst generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01FA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eErythromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMacrolides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DH03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eErtapenem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarbapenems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01BA02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThiamphenicol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAmphenicols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DE01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCefepime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFourth generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eComparing the results of 2021 with 2020, it is clear that the number of antibiotics used has decreased. That is, seventeen antibiotics were used in 2021. Of these, 5 were included in the \"Access\" group, 12 in the \"Watch\" group, and none in the \"Reserve\" group. 13-the antibiotic is included in the WHO OLS List, and 4 - are not included in the WHO OLS List.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eList of J01 antibiotics consumed in 2021, according to the WHO AWaRe classification\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e№\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eATC code\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAntibiotic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eClass\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBelonging to the List of essential medicines\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01СR02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmoxicillin sodium and potassium clavulanate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeta-lactam is a beta-lactamase inhibitor.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01GB06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmikacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAminoglycosides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01CA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmpicillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePenicillins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01XA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVancomycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGlycopeptides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01GB03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGentamicin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAminoglycosides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DH04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoripenem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarbapenems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01FA10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAzithromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMacrolides\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DH51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImipenem\u0026thinsp;+\u0026thinsp;Cilastatin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarbapenems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01MA12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLevofloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFluoroquinolones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01XD01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMetronidazole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eImidazoles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAccess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DH02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeropenem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarbapenems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01MA01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOfloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFluoroquinolones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DD04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCeftriaxone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThird generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DE01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCefepime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFourth generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DB04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCefazolin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFirst generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DD01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCefotaxime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThird generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ01DC02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCefuroxime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSecond generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA comparative analysis of the consumption of antibiotics for systemic use in 2019\u0026ndash;2021 shows that the level of antibiotic use in the Access group decreased from 39.13% in 2019 to 28% in 2020, and 22% in 2021. Thus, in the Aktobe dispensary hospital, there is a decrease in the consumption of antibiotics of the \"Access\" group. There is an increase in the consumption of antibiotics of the \"Watch\" group. That is, we noticed that in 2019 the \"Watch\" level was 60.87%, and in 2020 the level increased to 72%. The results of the comparison are presented in Fig.\u0026nbsp;1.2.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eUsing a chi-squared test, the proportions of antibiotics in the \"Access\" and \"Watch\" categories were compared between different years.\u003c/p\u003e \u003cp\u003eChi-square test results\u003c/p\u003e \u003cp\u003eChi-squared value: 5.77\u003c/p\u003e \u003cp\u003ep-value: 0.056\u003c/p\u003e \u003cp\u003eDegrees of freedom: 2\u003c/p\u003e \u003cp\u003eExpected frequencies:\u003c/p\u003e \u003cp\u003eAccess: [30.38, 30.38, 28.25]\u003c/p\u003e \u003cp\u003eWatch: [69.62, 69.62, 64.75]\u003c/p\u003e \u003cp\u003eA Chi-squared value of 5.77 indicates differences between observed and expected values, but not very high.\u003c/p\u003e \u003cp\u003eThe p-value (0.056) is close to the usual threshold of statistical significance (0.05). This means that although there is some evidence of changes in antibiotic consumption over the years, these changes are not significant enough to reject the null hypothesis of consumption stability over time.\u003c/p\u003e \u003cp\u003eBased on the analysis, it can be concluded that although there are some changes in the consumption of antibiotics of the \"Access\" and \"Watch\" categories in the period from 2019 to 2021, these changes are not statistically significant. This indicates a relative stability in the consumption of antibiotics of these categories during the study period.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAnd we also saw that the growth in the consumption of antibiotics at the \"Watch\" level remained unchanged by the results of 2021. To understand how often \"Watch\" antibiotics are used in Aktobe, we looked at the most consumed antibiotics.\u003c/p\u003e \u003cp\u003eIt should be noted that according to the results of 2020, we see that the most com-monly used antibiotics were of the cephalosporin group.\u003c/p\u003e \u003cp\u003eIn addition, we noticed that relatively in 2020, antibiotics from the \"Watch\" group ciprofloxacin, piperacillin-tazobactam, as well as antibiotics ertapenem, moxifloxacin, imipenem\u0026thinsp;+\u0026thinsp;cilastatin and lincomycin were often used during the pandemic, even if they were not included in the list of WHO essential medicines. These antibiotics were not used in 2019 before the pandemic.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs mentioned above, in general, during the period under review, we revealed a negative trend in the consumption of systemic antibiotics in all three categories of the WHO AWaRe classification. In the analysis of our study of the total consumption of antibiotics in accordance with WHO recommendations, a systematic decrease in the consumption of antibiotics was shown during the study period. That is, in the analysis of 2019 before the pandemic, the Access group showed a figure of 39%, in 2020 during the pandemic it was 28%, and in 2021 it decreased to 22%. The WHO AWaRe classification states that the consumption of antibiotics from the \"Access\" group should be at least 60%. On the contrary, more than half of the prescribed antibiotics in the Aktobe dispensary hospital were from the \"Watch\" group. During the study period, we found such a negative trend that the share of antibiotics consumed by the \"Watch\" group increased from 60.87% in 2019 to 71% in 2020\u0026ndash;2021.\u003c/p\u003e \u003cp\u003eAktobe is the western part of Kazakhstan, which accounts for 11% of the total area of the territory of Kazakhstan. The medical institution in which we conducted the study is one of the largest multidisciplinary medical centers in Aktobe, consisting of a surgical profile, a therapeutic profile, paraclinical units and a maternity service. Coronavirus infection was detected in our country in March 2020. Since that moment, on the basis of the order of the regional health department of the Aktobe region No. 68\u0026thinsp;\u0026minus;\u0026thinsp;5 dated April 16, 2020, the multidisciplinary hospital has been redesignated into a dispensary hospital. Since 2020, 2,223 patients with severe pneumonia in combination with various concomitant diseases COVID-19 have received inpatient treatment at the multidisciplinary dispensary hospital.\u003c/p\u003e \u003cp\u003eA study on antibiotic prescribing in India also revealed a similar practice: 46.80% of antibiotics from the \"Access\" group were prescribed a category, antibiotics from the observation group accounted for 53.19% of the total number of prescribed antibiotics [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In general, the consumption of antibacterial drugs corresponded to the hospital formulary and was prescribed under their nonproprietary names. According to standard treatment recommendations, antibacterial drugs were also prescribed to patients with pneumonia.\u003c/p\u003e \u003cp\u003eIn our study, third-generation cephalosporin antibiotics from the observation group were most often prescribed. Atif [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and others in the Republic of the Congo study reported that the most commonly prescribed drug was ceftriaxone from the third generation cephalosporin injection, which belongs to the observation category, which accounted for 31.1% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAccording to our research, we can see a similar result in the studies of other col-leagues in our country. That is, a comparative analysis of the consumption of antibiotics for systemic use in 2017\u0026ndash;2019 shows a decrease in the consumption of drugs of the Access group, and there is also an increase in the consumption of antibiotics of the Watch group. Thus, in Kazakhstan, there is a decrease in the consumption of antibiotics of the \"Access\" group from 39\u0026ndash;30% for the period 2017\u0026ndash;2019 [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor comparison with the study of England, the share of consumption of antibiotics of the \"Access\" group in 2016 was 60.9%, and \"Watch\" -37.9% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLet's also say that in Kazakhstan there is no state registration of antibiotics from the \"Access\" group \u0026ndash; cloxacillin, phenoxymethylpenicillin, spectinomycin and from the \"Reserve\" group \u0026ndash; ceftazidim\u0026thinsp;+\u0026thinsp;avibactam, meropenem\u0026thinsp;+\u0026thinsp;vabrobactam, plasomycin, polymyxin B. This undoubtedly limits the physical availability of key antibiotics, this is especially important for the \"Reserve\" group due to their use in life-threatening conditions associated with antibiotic resistance. There is also no registration of a number of medicinal forms of antibiotics from all groups of antibiotics according to the AWaRe classification. These are mainly oral liquid dosage forms and dosage forms for children. Some dosage forms of release and dosage of amoxicillin, chloramphenicol, clindamycin, doxacycline, metronidazole, nitrofurantoin have not been registered in the Access group in Kazakhstan. Some dosage forms of cefotaxime, piperacillin\u0026thinsp;+\u0026thinsp;tazobactam, and vancomycin ceftazidime have not been registered in the Watch group in Kazakhstan. Injectable fosfomycin and oral linezolid solution were not registered in the Reserve group.\u003c/p\u003e \u003cp\u003eDue to the lack of registration in Kazakhstan of a number of antibiotics and dosage forms (mainly liquid and children's), it is necessary to develop a state strategy to ensure their accessibility for practical healthcare and improve the quality of medical care [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Association of our country \"Professional Association of Clinical Pharmacolo-gists and Pharmacists\", created by all clinical pharmacologists of medical institutions in Kazakhstan, works at a high level with the aim of rational use of medicines. But despite the great work done to inform the population and medical workers, the problem of irrational consumption of antibiotics remains a serious problem for the Health Organization of Kazakhstan. We believe that one of the main reasons for the inappropriate use of antibiotics in Kazakhstan is the lack of clinical pharmacologists in the country's medical institutions responsible for achieving the effectiveness and safety of pharmacotherapy.\u003c/p\u003e \u003cp\u003eIn our previous pharmacoepidemiological study of antibacterial therapy in this hospital, it was revealed that the consumption of antibacterial drugs during the pan-demic period increased sharply compared with the pre-pandemic period, that is, the most noticeable increase in consumption was observed in the group of third-generation cephalosporins. In particular, ceftriaxone ranked first with the level of antibiotic consumption [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A similar situation in a large hospital, Almaty, Kazakhstan, 2020\u0026ndash;2021. most of the treatment methods did not meet national recommendations, including 98% of the use of anticoagulants, 95% of the use of antibiotics, 56% of the use of glucocorticoids and 56% of the use of antiviral drugs during the COVID-19 pandemic, respectively, cephalosporin antibiotics turned out to be the most commonly prescribed antibacterial drugs [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the updated 2021 AWaRe classification, 257 antibiotics used worldwide were assigned to the AWaRe groups (including all 39 antibiotics included in the WHO 2021 Indicative List of Essential Medicines and 36 antibiotics in the WHO Model List of Essential Medicines for Children). The 2021 standard lists include 31 Access and Watch antibiotics (about 6% of the 479 drugs in the standard lists) [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In a meta-analysis, researchers assessed the risk of colonization or infection with multidrug-resistant pathogens after exposure to antibiotics classified into AWaRe categories [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor comparison, in one systematic evaluation study, antibiotics used in 76 countries between 2000 and 2015 were classified into \"Access\", \"Watch\" and \"Reserve\" categories. This study showed that global antibiotic consumption increased by 90.9% in \"Watch\" antibiotics and by 26.2% in \"Access\" antibiotics between 2000 and 2015. The significant increase in the proportion of antibiotic \"Watch\" consumption was mainly caused by low- and middle-income countries, which increased by 165% compared with 27.9% in high-income countries. The rapid growth in the consumption of \"Watch\" antibiotics, especially in low- and middle-income countries, reflects problems in the rational use of antibiotics [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In addition, market analysis of antibacterial drugs sold in Pakistan, among which there are an excessive number of brands, belong to the \"Watch\" AWaRe category. The more brands there are, the higher the marketing pressure on doctors prescribing medicines will be [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion and Relevance","content":"\u003cp\u003eThe results of the study showed an alarming picture of the irrational consumption of systemic antibiotics in the Aktobe dispensary hospital. It was found that during the study period, the consumption of Access antibiotics decreased from 39.13\u0026ndash;72%. It was revealed that antibiotics of the \"Watch\" group were widely used during the pandemic in Aktobe. Antibiotics from the group of cephalosporins, fluoroquinolones, and carbapenems were often used in the \"Watch\" group. In general, the consumption of parenteral forms of systemic antibiotics prevails in the Aktobe dispensary hospital.\u003c/p\u003e \u003cp\u003eIn conclusion, our study highlights the need to implement the database of the AWaRe classification recommended by the World Health Organization in Aktobe as a tool to support setting performance targets and guide optimal use of antibiotics. To evaluate and monitor the use of antibiotics by creating and functioning a working group to control the validity of the use and prescription of antibacterial drugs in a medical organization in the Republic of Kazakhstan.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCOVID-19 \u0026nbsp; Coronavirus infectious disease 2019\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; World Health Organization\u0026apos;s\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAWaRe \u0026nbsp;\u0026quot;Access, Watch, and Reserve\u0026quot;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe express our gratitude to the management of the \u0026apos;Aktobe Medical Center\u0026apos; and the clinical pharmacologist of the medical center for providing the data for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, A.A.B., G.A.S., A.Z.M., M.S.K. and L.E.Z.; methodolo-gy, A.A.B.; software, A.A.B., B.L.S.; validation, A.A.B.; formal analysis, A.A.B., L.E.Z.; investiga-tion, A.A.B.; resources, G.A.S., A.Z.M.; data curation, A.A.B., G.A.S., A.Z.M.; writing\u0026mdash;original draft preparation, A.A.B.; writing\u0026mdash;review and editing, G.A.S., A.Z.M., M.S.K., L.E.Z.; visualiza-tion, L.E.Z.; supervision, G.A.S., A.Z.M., L.E.Z.; project administration, G.A.S., A.Z.M.; funding acquisition, B.L.S. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are partially included in this manuscript as quotes from survey responses; the complete survey answers are not made public for anonymity reasons.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have given consent for submission and potential publication of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared by all author\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003csup\u003e1\u003c/sup\u003e Department of Pharmacology, Clinical pharmacology, Department of Otorhinolaryngology, Ophthalmology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Russian Medical Academy of Continuous Professional Education, Moscow, Russia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u0026nbsp;\u003c/sup\u003e\u0026nbsp; Department of General and Clinical Pharmacology, Рeoples\u0026rsquo; Friendship University of Russia named after Patrice Lumumba (RUDN University named after Patrice Lumumba), Moscow, Russia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003e\u0026nbsp; Department of Pharmacology, Kazan State Medical University, Kazan, Russia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e5\u003c/sup\u003e\u0026nbsp; Aktobe Medical Center, Aktobe, Kazakhstan\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eth meeting report of WHO advisory group on integrated surveillance of antimicrobial resistance (AGISAR). 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(1), 107\u0026ndash;115. 10.1016/S1473-3099(20)30332-7 [PubMed] [CrossRef] [Google Scholar]\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"antimicrobial-resistance-and-infection-control","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aric","sideBox":"Learn more about [Antimicrobial Resistance and Infection Control](http://aricjournal.biomedcentral.com/)","snPcode":"13756","submissionUrl":"https://submission.nature.com/new-submission/13756/3","title":"Antimicrobial Resistance \u0026 Infection Control","twitterHandle":"@ARICJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"antibacterial drugs, antibiotic consumption, AwaRe, World Health Organization, antibiotics, COVID-19","lastPublishedDoi":"10.21203/rs.3.rs-4909317/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4909317/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis study presents a comprehensive analysis of antibiotic consumption in a dispensary hospital in Aktobe, Kazakhstan, from 2019 to 2021, utilizing the World Health Organization's (WHO) \"Access, Watch, and Reserve\" (AWaRe) classification.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThe primary objective of this study was to assess the patterns of antibiotic use in the hospital and to determine the extent to which the AWaRe classification could be effectively implemented in Kazakhstan to guide optimal antibiotic use and establish performance targets.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study analyzed data on the consumption of systemic antibacterial drugs in the dispensary hospital from 2019 to 2021. The usage of antibiotics was classified according to the WHO's AWaRe classification, which categorizes antibiotics into three groups: \"Access,\" \"Watch,\" and \"Reserve.\"\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study revealed a concerning trend in the irrational consumption of systemic antibiotics. There was a notable decrease in the use of \"Access\" antibiotics from 39.13% in 2019 to 22% in 2021, which is contrary to WHO recommendations. Conversely, the use of \"Watch\" antibiotics increased, particularly during the COVID-19 pandemic. The most commonly used antibiotics were cephalosporins, fluoroquinolones, and carbapenems.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings underscore the urgent need for implementing the AWaRe classification database in Kazakhstan to guide optimal antibiotic use, set performance targets, and establish a working group to monitor and control the prescription and use of antibacterial drugs. This study contributes to the global understanding of antibiotic consumption patterns and the challenges faced in adhering to international guidelines, particularly in the context of a pandemic.\u003c/p\u003e","manuscriptTitle":"Comparative assessment of antibacterial drugs used at the hos-pital level before and during COVID-19, according to the WHO AWaRe classification","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-11 08:55:54","doi":"10.21203/rs.3.rs-4909317/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2024-08-18T12:36:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-15T01:45:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Antimicrobial Resistance \u0026 Infection Control","date":"2024-08-13T20:26:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"antimicrobial-resistance-and-infection-control","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aric","sideBox":"Learn more about [Antimicrobial Resistance and Infection Control](http://aricjournal.biomedcentral.com/)","snPcode":"13756","submissionUrl":"https://submission.nature.com/new-submission/13756/3","title":"Antimicrobial Resistance \u0026 Infection Control","twitterHandle":"@ARICJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7becdfe7-8e98-40f6-990c-55b4a3fdd9fe","owner":[],"postedDate":"September 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-09-11T08:55:54+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-11 08:55:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4909317","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4909317","identity":"rs-4909317","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}