The problem of antibiotic (antibacterial drugs) resistance has gained particular importance throughout the world and has become especially acute during the COVID-19 pandemic due to the massive, often unjustified use of broad-spectrum antibiotics (ABs). Currently, bacterial strains have emerged that are resistant to almost every antibiotic, and creating a new drug is much more difficult than before.
Resistance to AB in the developed countries of the world is considered as a threat to national security. According to international experts, antimicrobial resistance was the cause of more than 700,000 deaths annually (22,000 in Europe) in the pre-pandemic period. It was assumed that by 2050 this figure could increase to 10 million people with an increase in the associated costs of the health care system up to $1 trillion. Over the years of the pandemic, negative trends have only intensified.
One of the effective tools for managing antimicrobial therapy in healthcare facilities is the DDD analysis of the consumption of reserve antibiotics. The system is based on the monitoring of the universal unit of measurement of drug consumption Defined Daily Dose (DDD).
Management of antimicrobial therapy is a set of long-term multifaceted activities to improve the practice of prescribing antibacterial drugs in order to increase clinical and cost-effectiveness, as well as the safety of treatment.
The concept of optimal pharmacotherapy includes the choice of the most appropriate drug in a particular clinical situation, its dosing regimen, route of administration and duration of treatment.
Depending on the diagnosis, the patient’s condition, and the properties of the drug, combination, stepwise, and/or de-escalation therapy may be considered. At the same time, the main goal of most AMT management programs is to ensure effective treatment of patients with infectious diseases while minimizing the undesirable consequences of AB use.
The cornerstone of any AMT control program is the quantitative measurement of AB use. This requires a unified classification system for medicines (PM) and units of measurement for their consumption. The standardized unit of measure for drug use is the established daily dose.
According to the WHO definition, DDD is the basic international unit of drug use, representing the average maintenance dose of a drug used in 80% of treated adult patients for the main indication. Simply put, the DDD is the amount of drug each adult patient will receive daily to treat an infection.
DDD is a formalized unit of measurement and therefore does not always reflect the recommended or prescribed daily dose of the antibacterial drugs. The established daily doses are not clinical doses. Actual therapeutic doses in individual patients or groups of patients are often different from the DDD, as they are based on individual characteristics (age, weight, pharmacokinetics, etc.).
For a number of drugs (sera, vaccines, anticancer drugs, allergens), DDD has not been established. Information on the DDD value of a particular drug can be found at whocc.no
Antibacterial drugs and DDD
DDD analysis is one of the most effective tools for managing antimicrobial therapy. The NDDD of reserve antibiotics per 100 treated patients is a tense indicator that reflects the degree of antibiotic resistance not only in the reserve antibiotics, but also in the basic antibiotics used and in epidemiological problems, requiring healthcare professionals to work daily with complex patients with the adoption of multifunctional complex clinical decisions, incl. h. to preserve the sensitivity of microorganisms to AB.