DOI: 10.11648/j.wjhpm.20260101.12 ISSN:

Integrating Clinical Stewardship and Institutional Management to Control Antimicrobial Resistance in Primary Care During Wartime in Ukraine

Roman Grytsko
Show PDF Cite
Background: Antimicrobial resistance (AMR) remains a growing global health threat, and in Ukraine the burden is compounded by unregulated over-the-counter access to antibiotics, disruption of routine immunization, and reduced microbiological diagnostic capacity across primary care facilities reorganized into Territorial Medical Associations (TMOs) since the 2018 healthcare reform, all occurring against the backdrop of full-scale war. AMR stewardship at the primary-care level continues to be framed almost exclusively as a clinical rather than a managerial task, which weakens the effectiveness of local antibiotic stewardship programs. Objective: To substantiate a practical framework that integrates evidence-based clinical principles of rational antibiotic therapy with institutional management mechanisms at the primary healthcare facility level, in order to strengthen AMR containment in primary care under conflict conditions. Methods: A narrative synthesis of international evidence on AMR control was conducted, covering the One Health concept, the “Start Smart – Then Focus” antibiotic stewardship principle, the WHO AWaRe antibiotic classification, point-of-care diagnostics, and immunization policy, integrated with the authors’ own prior work on managerial dysfunction in Ukraine’s polyclinic-outpatient network. Sources were retrieved from Cochrane Library, PubMed/MEDLINE and Journal Citation Reports-indexed journals, prioritizing systematic reviews, meta-analyses and multicentre validation studies published through 2026. Results: Five interdependent levers were identified as decisive for stewardship effectiveness at the facility level: a locally adapted first-line antibiotic formulary; routine antimicrobial consumption monitoring; prescribing audit and feedback; point-of-care C-reactive protein and rapid antimicrobial susceptibility testing; and vaccination policy as an upstream AMR-prevention tool. Conflict-related amplifiers — including extensively drug-resistant Gram-negative pathogens associated with war wounds and their documented spread into referral networks — further elevate the managerial stakes for primary care. Conclusion: Containing AMR in primary care is a joint clinical-managerial task. Evidence robustly supports each stewardship element individually, but institutional mechanisms determine whether these elements are reproduced systematically across a facility rather than remaining dependent on individual clinician initiative. Treating antibiotic stewardship as a management function of the TMO, not solely an individual physician’s discipline, is a promising direction for strengthening national AMR control programs under wartime conditions.

More from our Archive