11, 12, 13, 14, 15 June 2017 CCT PCr SDIINIGES OK IConiacirs Thea fet Them MeL d1co) Peer amy A bade DAAC RETA CDs. ww.bioscopegroup.org BIOSCOPE ea Ronco melee ne]IC?AR 2017 Proceedings Book P 23 - Antibiotics in Serbian households: use and misuse Milica Paut Kusturica', Ana Tomas!, Olga Horvat, Marko Milovie?, Zdenko Tomi!, Ana Sabo! Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Novi Sad, Serbia 2Facully of Medicine, University of Novi Sad, Serbia Abstract Background: Irregular antibiotic use, including self-medication, contributes to the development of antibiotic resistance. One method of accessing antibiotic use in the community is through obtaining an in house inventory of drugs. The aim of this study was to investigate the extent of storage and self-medication with antibiotics in households in Novi Sad, Serbia, Materialimethods: The study was performed during a 4-month period (October 2015 - January 2016) using a convenience sample of households in Novi Sad, Serbia. Sample size was calculated by the results from the 2012 study where the share of antibiotics in Novi Sad households was 7.3%. With a confidence interval of 95% and 5% precision, necessary sample size was 89, Considering a low response rate noted in previous study, 300 households were contacted and 112 agreed to participate. The study protocol was approved by the Ethical Committee of the Facuity of Medicine in Novi Sad. Two trained interviewers performed the survey by visiting each household. The study consisted of making an inventory of all drugs in household and a semi-structured interview about antibiotic use practices and perceptions. The collected data were analysed using SPSS V.16, Results: Out of 112 surveyed households, antibiotics were encountered in 55 (49.1%). Antibiotics constituted 11.98% (92/768) of total number of drug items in households. In households that had antibiotics, average number was 1.73+1.02. Only demographic variable that influenced the amount of antibiotic in households was education — households where the person responsible for home-pharmacy had elementary education had lower number of antibiotics compared to those with higher education (p=0.021). Presence of children younger than 12 years in household and health professional did not influence the amount of antibiotics stored. Out of all antibiotics in households, 41 (44.57%) were not in current use, and presented left-overs from previous treatment courses (these packages contained 1-2 pills, majority of unused packages contained less than half a package, and a quarter contained only 1-2 pills). This amount of left-over antibiotics raises a concern about patient compliance, Out of antibiotics currently used (51, 55.44%), self-medication was noted for 21.56% packages. Antibiotics used for seltmedication were mostly purchased in pharmacies without prescription or acquired through social contacts (friends or family). The antibiotic most commonly used for self- medication was amoxicilin (reported indications included common cold, cough, pharyngitis and tooth-ache). Conclusions: Antibiotics were present in large share of households in Novi Sad. Self- ‘medication with antibiotics, and sale of antibiotics without prescription represent an important problem. Education of general public about antibiotics especially the importance of regular use, handing left-overs and consequences of self-medication is necessary. Acknowledgements This work was supported by the Ministry of Science and Technological Development, Republic of Serbia, project No. 41012 288IC?AR 2017 Proceedings Book P 24 - Significance of mutant selection window and mutant prevention concentration concepts: a review ‘Ana Tomas!, Milica Paut Kusturica’, Zdenko Tomié!, Olga Horvat, Marko Milovie? Jovana Trifunovis, Ana Sabo! 'Deparlment of Pharmacology, Toxicology and Clinical Pharmacology, Facully of Medicine, University of Novi Sad, Serbia 2Facully of Medicine, University of Novi Sad, Serbia Abstract The mutant selection window (MSW) concept offers knowledge of relationship between antibacterial pharmacodynamics and resistance development which is crucial for optimizing the use of existing antibacterial agents. It is based on a novel pharmacodynamic measure of antibiotic potency - the mutant prevention concentration (MPC). This review aimed to explore these concepts with a special regard to their clinical applicability. A literature search (-2015) using keywords ‘mutant prevention concentration’ or ‘mutant selection window’ and ‘antibiotic ‘or ‘antibiotics’ or ‘antibacterial’ of PubMed database was conducted, Search yielded 450 results, after checking the tiles, and 181 abstracts, 84 articles were assessed in fll lxt, The concept of MSW was first reported in 1999 in relation to fluoroquinolones. Within a susceptible wild-type population, a fraction of bacterial calls is not affected when subjected to an antibiotic. This subpopulation carries mutations that inhibit antimicrobial action, allowing their selection during linical treatment. Multiplication of this resistant subpopulation occurs in a range of concentration (MSW) between the MIC of the susceptible cells, and the mutant prevention concentration (MPC). MPC represents a concentration of antibiotic that prevents the development of first-step resistant mutants - the MIC of the least drug-susceptible mutant subpopulation. Multiple in vitro studies that monitored the increase in MIC after bacterial exposure to different concentrations of antibiotics, confirmed that resistant mutants are selectively enriched when antibiotic concentrations remain within MSW. Besides fluoroquinolones, this hypothesis has been tested for other classes of antibacterial agents such as polimixines, macrolides, aminoglycosides and beta-lactams in vitro. MSW has been widely confirmed in vitro, but nat all generated data agree with the results attained in vivo (ic. fosfomycin). The mutant selection window concept is definitely relevant for fluoroquinolones based on in vitro and in vivo experiments, but further research is necessary to determine the applicability of MSW in vivo for other antibacterial groups. For fluoroquinolones, MSW determined in vitro can be a reliable tool for guiding the optimization of antimicrobial treatment regimens for suppression of the selection of antimicrobial resistance, and clinical implementation of selection window dosing strategy is feasible. Acknowledgements This work was supported by the Ministry of Science and Technological Development, Republic of Serbia, project No. 41012 289