Bacteria can develop resistance to antibiotics, and when they do, medicines that once worked stop being effective. This phenomenon is called antibiotic resistance.

It is important to distinguish between antibiotic resistance and antimicrobial resistance (AMR). AMR is a broader term that covers the resistance of different microorganisms to medicines, while antibiotic resistance refers specifically to bacteria and antibiotics.

For Ukraine, this issue is particularly relevant in the context of the war. The large number of severe injuries, surgical and invasive procedures, prolonged treatment, movement of patients between healthcare facilities, and high pressure on hospitals create additional risks of the spread of resistant microorganisms.

But the response to this challenge begins long before hospitalization.

One of the places where decisions that affect the spread of antibiotic resistance are made every day is the family doctor’s office.

Primary Care as the First Point of Clinical Decision-Making

For many patients, a primary care physician is their first point of contact with the healthcare system.

It is here that the doctor decides whether there are grounds for antibiotic therapy, whether symptomatic treatment is sufficient, whether additional examinations are needed, and when the patient needs to be referred further.

This is particularly important for common conditions that people bring to their family doctor: acute respiratory infections, sore throats, coughs, fever, urinary tract infections, and other illnesses.

The problem arises when an antibiotic is prescribed without sufficient indications, when a patient buys medication on their own, or changes the treatment regimen based on previous experience.

Therefore, combating antibiotic resistance at the primary care level is not a separate task for a doctor, but part of everyday clinical practice.

“Most often, everything begins during a routine visit to a family doctor: the patient has had a fever, cough, or sore throat for several days and asks for an antibiotic ‘so that it doesn’t turn into pneumonia.’ At this point, it is dangerous to make a decision based on a single symptom or simply because of the patient’s expectations. The clinical condition needs to be assessed comprehensively: the severity, duration, and dynamics of symptoms, warning signs, comorbidities, and the risk of complications. It is essential to ask what the person has already taken, whether they have used antibiotics recently, and whether they have experienced any allergic reactions.

Typical mistakes in practice include prescribing an antibiotic ‘just in case,’ choosing a broader-spectrum medicine than necessary, or failing to explain when a follow-up examination is needed. Sometimes the main mistake happens even earlier: the doctor does not find out what exactly the patient is afraid of and what they expect from treatment,” notes Maksym Bezrukyi, epidemiologist, infection control expert, and medical analyst.

The Patient Expects an Antibiotic. What Should the Doctor Do?

One of the practical challenges in primary care is the patient’s own expectations.

A person comes in with a fever, cough, or sore throat and may be convinced that treatment will not be effective without an antibiotic. For the doctor, this means not only making a clinical decision but also explaining it to the patient.

The phrase “You don’t need an antibiotic” does not always answer the person’s main question: “So what should I do?”

Therefore, it is important to explain the reason for the decision, describe possible ways to relieve symptoms, identify signs of deterioration, and specify when the patient should seek medical attention again.

This is how responsible attitudes toward antibiotics are developed — not through prohibitions, but through clear communication.

“When a doctor simply says, ‘You don’t need an antibiotic,’ the patient often hears: ‘I don’t want to treat you.’ It is better to structure the conversation differently: ‘I have examined you, and at the moment I do not see any signs that an antibiotic would help. But we can relieve your symptoms and monitor how your condition changes, adjusting the treatment if necessary.’

Then specifics are needed: how to relieve the symptoms, how long they may last, and when the patient should start feeling better. At the end, it is important to clearly agree on what signs should prompt the patient to seek help earlier and when to come for a follow-up examination if there is no improvement. Such a plan and the possibility of follow-up contact preserve trust much better than a brief refusal,” assures Maksym Bezrukyi, epidemiologist, infection control expert, and medical analyst.

Five Situations Where Primary Care Decisions Matter

1. A Patient with Cold Symptoms Asks for an Antibiotic

The doctor’s task is to assess the patient’s condition, determine the likely cause of the illness, and explain why an antibiotic is or is not needed in the specific situation.

2. The Patient Has Started Taking a Medicine on Their Own

It is important to find out exactly which medicine they are taking, at what dosage, and for what reason, and only then determine the further course of action.

3. “The Antibiotic Helped Last Time”

Previous experience does not mean that the same medicine will be appropriate for a different illness. The same symptoms can have different causes.

4. The Patient Wants to Stop Treatment Because They Feel Better

Patients should not change the prescribed treatment regimen on their own. They need to understand exactly how they should take the medicine according to the doctor’s prescription and when they need to seek medical attention again.

5. Symptoms Persist or Get Worse

In this situation, it is important not simply to “step up” treatment with an antibiotic, but to reassess the patient’s condition, review the diagnosis, and determine the further course of action.

Antibiotic resistance cannot be explained by a single inappropriate prescription. It is influenced by antibiotic prescribing, infection control, epidemiological surveillance, patient transfers, hospitalizations, the use of medical devices, and many other factors.

Therefore, primary care is only one part of the system. Its decisions need to be connected with the work of hospitals, laboratories, infection control specialists, and the epidemiological surveillance system.

It is precisely this interaction that makes it possible to speak about the rational use of antibiotics — Antimicrobial Stewardship — as a systemic approach rather than an isolated prescribing practice.

Maksym Bezrukyi, epidemiologist, infection control expert, and medical analyst, emphasizes: “A patient does not start treatment from the beginning every time they are admitted to or discharged from a hospital. If some information is lost during the transition, the family doctor may not know why an antibiotic was prescribed in the hospital, how long antibiotic therapy has already been ongoing, or when the treatment should be completed. At the same time, the hospital may not know about recent antibiotic use, allergic reactions, or previous test results. As a result, medicines may be duplicated, treatment may be unnecessarily prolonged or changed, and in the case of allergic reactions, this can even pose a threat to the patient’s life.

Infection control in the context of AMR prevention works on a very practical level: hand hygiene, safe procedures, the proper use of personal protective equipment, and preventing the transmission of infections reduce the number of people who will need antibiotics in the first place. The logic is simple: fewer infections — fewer prescriptions; less transmission of resistant microorganisms — fewer complicated cases.”

Several practical things do not require a separate reform or new resources:

• Justified prescribing

Antibiotics are prescribed based on clinical indications and in accordance with current recommendations.

• Clear communication

The patient should understand why an antibiotic has or has not been prescribed.

• Monitoring self-medication

A healthcare professional can ask about medicines the patient has already taken on their own and adjust the further course of action.

• Infection safety

Compliance with hand hygiene, the use of personal protective equipment, and other infection control measures reduces the risk of infection transmission.

• Vaccination

Preventing infections reduces the number of illnesses and, consequently, the need for antibiotics in situations where they are truly necessary.

As part of an international program, ZDOROVI, together with ReAct, is working to strengthen infection control and antimicrobial resistance prevention systems in Ukrainian healthcare facilities.

The focus is on developing the professional and managerial capacity of healthcare workers in healthcare facilities, modern approaches to infection control, the rational use of antibiotics, and the development of infection safety practices.

An important principle of the project is that training should translate into daily practice. Therefore, it is not only about gaining new knowledge, but also about applying it in the work of medical teams.

For a patient, a doctor’s decision to prescribe an antibiotic may seem like a small part of a consultation. For the healthcare system, such decisions are made thousands of times.

That is why combating antibiotic resistance requires not one decision, but consistent work at different levels — from the family doctor’s office and infection control to laboratory diagnostics, epidemiological surveillance, and management decisions.

Primary care has a clear role here: to properly assess the patient’s condition, prescribe treatment based on sound clinical reasoning, explain the decision, and prevent unnecessary use of antibiotics.

Every such decision is part of a larger system that determines how effective antibiotics will remain for patients in the future.

The program is implemented by ZDOROVI in cooperation with the international ReAct network and with the support of Swedish experts.