INTRODUCTION

Injuries to the extremities by modern types of firearms are manifold, extensive destruction of soft tissues and bones are often damage to the major vessels and nerve trunks, as well as tearing of segments of limbs [1, 2].  The presence of crushed tissues, freely lying bone fragments, blood clots, and soft tissues in the wound, creates favorable conditions for the development of wound infection [3-6].

RESEARCH MATERIALS AND METHODS

Marketing research is aimed to study the structure of prescription medicine, determining the groups of drugs used in the treatment of a defined range of wounds. As well as astreatment policy analysis and sales of drugs used in the treatment of wounds, including as a result of

gunshot wounds.

This study examined the appointment of surgeons, traumatologists, and anesthesiologists as specialists, who help the largest number of these patients.

RESULTS AND DISCUSSION

The analysis of the appointment lists showed that 688 medicines were assigned for the period 2014-2019. In 2015, 186 medicines were assigned, and in 2019 - 166 medicines commercial names. The list of drugs most commonly found in appointments listed in Table. 1 [7, 8].

Table 1: List of medicines commonly found in medical prescriptions

Table 1 shows that among the most popular medicines, among medicines are antibiotics (especially cephalosporins and fluoroquinolones groups), non-steroidal anti-inflammatory medicines (NSAIDs (diclofenac, ketorolac, nimesulide)), antiseptics (chlorhexidine), agents for infusion therapy (atnukozid, Novocaine, lidocaine) are the popular trade names of medicines have changed during the period under review [9].

The structure of assignments by anatomical-therapeutic (ATC) codes of level 1 are given in the Table 2.

Table 2: Assignments structure by ATC of level 1

The results of this study showed that most often prescribe medicines from the 5 major groups (J, D, M, N, B) are 83.59% of appointments, are the leaders of antibiotics [10].

The assignments structure for ATC 2-level codes is given in Table 3.

Table 3: Assignments Structure by ATC of level 2

At the 2 levels of the ATC classification, more than half of appointments are occupied by 3 groups of medicines - antibiotics, antiseptics, and analgesics. Therefore, for the investigated specialties of physicians, the primary task is to stabilize the patient, eliminate pain, and prevent wound infection.

At the 3 levels of ATC classification, medicines from 65 classification groups are used (Table 4).

Table 4: Assignment structure for ATC codes at 3 levels

Medicines are purchased at the patients' own expense (pharmacy retail sales) and from the state and local budgets (hospital sales). The retail segment is over 80% in cash.

In the retail segment, antiseptics and disinfectants, NSAIDs, and anti-inflammatory medicines, antibiotics (primarily β-lactates), topical painkillers, antihistamines, and infusion therapy solutions account for the largest share (before cash segment sales in 2018).

Antibiotics and antiseptics also lead in the hospital segment, infusion solutions, and specific anesthesia and opioid analgesics are the most common (Table 5).

Table 5: The structure of prescriptions  medicines by ATC codes 3 levels of  hospital segment

In the next phase of research, we analyzed the retail pharmacy sales of medicines used in the treatment of exposed wounds, including as a result of gunshot wounds.

Table. 6 shows the TOP 30 of 128 medicines with International Non-proprietary Names (INN) according to the appointments of surgeons, traumatologists, and anesthetists (for 2018) [8, 10].

Table 6: TOP 30 medicines for INN

It has been proven that in the analysis of pharmacy sales, the above-mentioned medicines are used in addition to the the treatment of open and gunshot wounds. However, as well as the structure of medical prescriptions, it is shown that antibiotics (beta-lactams, fluoroquinolones, and macrolides), antiseptics (hydrogen peroxide, solution of brilliant green, iodine, chlorhexidine), NSAIDs (diclofenac, ibuprofen, ibuprofen, mediproxen, ibuprofen, ibuprofen, ibuprofen ), anesthetics (lidocaine, novocaine) and so on.

Dynamics Analysis of sales of the top 30 medicines (Fig. 1) by INN (in the packs) shows a tendency to reduce  metamizole sales and the growth of ibuprofen and nimesulide. The sales dynamics of Diclofenac remain unchanged.

Among the antiseptic group, sales of hydrogen peroxide remained unchanged, while at the same time sales of green diamond and iodine have decreased. Among antibiotics, increased cephalosporins position and some extent macrolides have lost the selling position of penicillins [5].

Figure 1: Sales Dynamics charts of the top 30 INN in packages

As of December 2019, domestic medicines account for more than two-thirds of sales (in packs) in the analyzed segment (Fig. 2).

Figure 2: Particle diagram of domestic and imported drugs in the unitary enterprise

By 2014, imported medicines were increasing packaging sales. After the crisis of the 2014 and the rapid increase of the hryvnia exchange rate, their sales in packaging have declined somewhat, only in recent years the upward trend has resumed (Fig. 3).

Figure 3: Dynamics charts of sales of domestic and imported drugs in the unitary enterprise

In the segment of agents used to treat open wounds and gunshot wounds from 2008 to 2018 represented 267 manufacturers. Since 2018, only 104 manufacturers had more or less significant sales, with 22 manufacturers providing 85% of the segment's packaging needs (Fig.4).

Figure 4: Dynamics diagrams of manufacturers particles in a unitary enterprise