This Bulgarian National Program for the rational use of antibiotics and surveillance of antibiotical resistance planned for the period from the year 2017 until the year 2021 consists of fifteen action points in four key areas: I. Surveillance; II. Preventive and prophylactic measures; III. Research and development of new products; IV. International cooperation. The aim of this program is to synchronize (adapt, support, organize) the implementation of the national strategy for the rational use of antibiotics and the antibiotic resistance surveillance system in Bulgaria, in accordance with EU requirements for member states. This text outlines that the two main areas for the management, control and prevention of antibiotic resistance are: prudent use of antimicrobial drugs (i.e. only when needed, at the right dose, at the right dose intervals and for the right duration); hygiene measures to control the transmission of resistant microorganisms (infection control), including hand hygiene, screening, isolation, etc. These thematics are applied for both human and animal (veterinary) medicine and health approach. To implement this Progam, criteria for the appointment and use of antimicrobials should be approved. It is necessary to implement a national strategy for infection prevention, rational use of antibiotics and combating the spread of antibiotic resistance, in accordance with EU requirements for the member states of the union. For the functioning of this strategy, certain criteria for the appointment and use of antimicrobials should be defined and observed. It is important to provide reliable and comparable data on the prevalence, frequency, dynamics and mechanisms for the spread of resistant microorganisms through correct surveillance systems. The surveillance strategy that addresses the problem of antibiotic resistance should be comprehensive and, in particular, assess the potential link between the use of antibiotics and the development of resistance. An important step is to avoid or more precisely reduce the further emergence of resistant microorganisms by reducing the unnecessary and inappropriate use of antimicrobials. The general principles and methods for the appropriate use of these drugs must be updated, concretized, and applied in practice. To achieve the goal, the following tasks are envisaged: 1. To synchronize with European legislation the implementation and functioning of a rational antibiotic policy on a national scale, based on limiting the free sale and non-indicated use of antibiotics in human, veterinary medicine and agriculture, the surveillance of antibiotic resistance and modern criteria of rational antibiotic policy (microbiological, pharmacological and therapeutic); 2. Constant standardization and control of methods for determining susceptibility to antimicrobial agents; 3. Organizing the ongoing implementation of intra- and extra-laboratory control of methods for identification of microorganisms and determination of their susceptibility to antimicrobial agents; 4. Administration, improvement and constant functioning of a system for institutional and national surveillance of antibiotic resistance and antibiotic use in human medicine – BulSTAR; 5. Development of a national system for surveillance of antibiotic resistance in veterinary medicine and agriculture; 6. Administration and permanent operation of the national computer program for management in the microbiological laboratories of the NIS “KMNI”; 7. Training of medical personnel and dissemination to the public of the necessary amount of information on the benefits and harms of antibiotics, their rational use, and the adverse effects of self-medication; 8. Implementation of permanent control of infections in hospitals (Commissions on Hospital Infections - KBI, accreditation mechanisms) .
بلغاريا · 2017-01-01