Surgical clinic for the treatment of tuberculous exudative pleurisy: availability of anti-tuberculosis medicines

Abstract

Introduction. Tuberculous exudative pleurisy remains a difficult clinical problem for surgical practice, especially in wartime conditions, with disruptions in organization and limited access to medicines. The peculiarities of the disease course, the difficulties of diagnosis, and the need for invasive verification methods lead to delays in establishing a diagnosis and initiating treatment. The effectiveness of pharmacotherapy depends not only on the pharmacological properties of anti-tuberculosis drugs but also on the stability of their availability in the pharmaceutical market. Objective. To assess the availability of anti-tuberculosis drugs in the pharmaceutical market of Ukraine using clinical content analysis to ensure continuous pharmacotherapy for patients with tuberculous exudative pleurisy in surgical clinics. Materials and methods. The study was conducted in 2022–2026. The object of the study was anti-tuberculosis drugs in circulation in Ukraine. The clinical content analysis technology was used, based on the principles of evidence-based medicine, evidence-based pharmacy, and clinical-pharmacological analysis. Regulatory documents, clinical guidelines, instructions for medical use, and data from the State Register of Medicines of Ukraine were analyzed. Methods of grouping by manufacturer, statistical data processing (Sturges' formula), and regulatory, documentary, marketing, and graphic research methods were applied. Results. The presence of 41 names of anti-tuberculosis drugs on the pharmaceutical market of Ukraine was established. 4 groups of manufacturers were distinguished by the breadth of their assortment and the stability of their supply. It was found that most drugs have confirmed production quality (GMP) and bioequivalence; however, there are gaps in the availability of fixed combinations and pediatric formulations. It has been shown that the continuity of pharmacotherapy depends on the availability of alternative manufacturers, the diversity of dosage forms, and the stability of supply. Discussion. Content analysis, as an innovative tool, allows for the systematization of information about medicines and its linking to clinical needs. The results emphasize the importance of organizational support for treatment, including formulary development, procurement planning, and continuity of therapy. Attention should be paid to the risk of pharmacokinetic alterations associated with pleural localization, which may affect treatment effectiveness. Conclusions. Clinical content analysis technology is an effective tool for assessing the availability of anti-tuberculosis medicines and optimizing pharmacotherapy of tuberculous exudative pleurisy. The need to provide at least two alternative manufacturers for each active substance, and the availability of fixed combinations to increase treatment adherence and prevent therapy interruption, have been identified. The results of the study can be used to inform the development of local protocols, formularies, and procurement planning in healthcare institutions.