Fighting for the proper use of antibiotics: the experience of one doctor in the former Yugoslav Republic of Macedonia

Dr Katarina Stavric has been practicing medicine for 26 years. She is a paediatrician working at University Children’s Hospital in Skopje, capital of the former Yugoslav Republic of Macedonia. She is a specialist in the Department of Immunology, and since 2010 she has also filled the role of Coordinator of the Centre for Family Medicine. She says she has seen a rise in antibiotic-resistant bacteria since she started her career in medicine.

Why do you think there has been a rise in antibiotic-resistant infections?

They are still not common, but I think the increase is probably due to people using broad spectrum antibiotics improperly.

What does an antibiotic-resistant infection mean for a patient? How does it differ from a normal infection that can be treated with antibiotics?

It means a longer hospital stay, potentially serious complications and the risk of bad outcomes for the patient. It also means an expensive hospital stay that often can’t be covered by the usual system of payment. The parents and families are usually very worried.

What steps do you take to prevent infections among your patients? How do you ensure that infections are treated properly?

Hand hygiene is the most important way to protect children from infection. In front of each hospital room we have hand disinfectant, and we also use the practice of washing hands with water and soap before each procedure with sick children.

In terms of treatment, I try to be rational when prescribing antibiotics. I take care to learn the patient’s previous history on the use of antibiotics, and I prescribe them only if they are truly necessary. I take care to choose the right antibiotic, prescribe it in the right dose and for the right duration.

How do you interact with parents who may be very eager to have you prescribe antibiotics for their children?

I spend a lot of time explaining why antibiotics are not a magic drug. I also explain how to protect the child from infection, including by following the recommended immunization schedule, healthy hygiene habits and so forth. Most of my patients accept my advice and they trust me.

Do you find your peers to be well-informed about the threat of antibiotic resistance? If not, how do you work to educate them?

In my department, we are all fighters against the abuse of antibiotics and we are involved in continuing medical education for paediatricians. I am also involved in educating general practitioners on the rational use of antibiotics. I collaborate with them on surveys that examine prescribing habits among primary care providers.

You call yourself a fighter against the improper use of antibiotics. As such, what message do you want to spread about antibiotic resistance to your fellow health care workers and to policy-makers?

We have to act urgently. If we are not careful with prescribing antibiotics, we can lose the battle with bacteria and we will see more severe infections with poor outcomes in the future. It is not too late to prevent antibiotic resistance and to preserve the effectiveness of antibiotics.

I encourage health care providers to collaborate closely, share information and restrict the prescription of antibiotics to severe infections only. We also need health care workers to educate patients about infection prevention and on the appropriate use of antibiotics.

For policy-makers, I recommend updating guidelines and hospital protocols according to local antibiotic resistance. Furthermore, implementation of these guidelines should be monitored, along with the effectiveness of interventions.