Healthcare. Pleurisy: clinical and diagnostic guidelines, treatment tactics, legal principles

38 P.- Annals of Mechnikov Institute. 2025. N 4 www.imiamn.org.ua /journal.htm DOI: 10.5281/zenodo.17923074 HEALTHCARE. PLEURISY: CLINICAL AND DIAGNOSTIC GUIDELINES, TREATMENT TACTICS, LEGAL PRINCIPLES Oleksandr Nevzghoda1, 3, Viktoriia Shapovalova2, 4, Alina Osyntseva3, 4, Valentyn Shapovalov2, 4, Valerii Shapovalov2, 4 1Danylo Halytsky Lviv National Medical University 2Private Scientific Institution “Scientific and Research University of Medical and Pharmaceutical Law” 3Lviv Medical University 4Public Organization “Association of Medical and Pharmaceutical Law”, Ukraine Introduction Pleurisy is a significant clinical problem, accompanied by an increase in the duration of hospitalization, the need for invasive interventions and the risk of complications. Pleural infections are associated with increased mortality and a significant resource burden on hospitals [1,2]. In the USA, approximately 1.5 million pleural diseases are recorded annually. In 2016 alone, 361,270 hospitalizations with pleural conditions were recorded, which amounted to approximately $10.1 billion in direct costs. The frequency of hospitalizations with empyema increased from 3.04 to 5.98 per 100 thousand population between 1996–2008 [3-5]. In Ukraine, nationwide registries are limited. However, according to individual clinical series in 2024– 2025, large centers report tens to hundreds of cases of acute empyema. For example, a single-center surgical study in 2024 included 107 patients with destructive processes of the lungs and pleura, illustrating the significant clinical burden in large hospitals. During COVID-19, the proportion of empyema in critically ill patients could reach 7.3% [6]. Clinical and diagnostic guidelines for the treatment of pleurisy are based on evidence-based principles. Current evidence-based guidelines for the diagnosis and management of the most common pleural conditions include ultrasound diagnostics, computed tomography, staged treatment tactics, surgical consultations, and pharmacotherapy [7]. The role of interdisciplinary consensus of pulmonologists, thoracic surgeons, and clinical pharmacologists regarding pleurisy in adults is emphasized in Bedawi E., Ricciardi S., Hassan M. et al. Small-caliber drainage under visualization control as an appropriate primary intervention in most cases, avoiding delays [8]. About clinical and diagnostic landmarks of pleurisy when combining invasive intervention methods, improving drainage, reducing the frequency of referrals for surgery, reducing hospitalization is given in Rahman N., Maskell N., West A. et al. [9]. Retrospective analysis of pleural diseases, pleurisy with the formulation of criteria was started as early as 1972 by Light R.W. et al. [10]. However, today the historical study of 1972 does not consider modern scenarios of pleurisy treatment tactics. Therefore, detailed modern warnings should be taken from newer guidelines and studies [7, 11-15]. Along with clinical and diagnostic guidelines, organizational solutions that ensure continuity of treatment and avoid unjustified drug prescriptions are important in medical practice. To support clinical decisions, an organizational and resource tool based on the ABC/VED analysis method is used [16-29]. The treatment tactics of pleurisy involves the prescription of antibacterial drugs. Given the high cost of some antibacterial drugs and their impact on patients, effective management of drug supplies in healthcare institutions requires a systematic approach. Among drugs with antibacterial action in the treatment of pleurisy, antibiotics occupy a leading place, which provide etiotropic control of infection and proven clinical efficacy. Antibiotics are most often used for systemic therapy, since they have predictable pharmacokinetics, a spectrum of activity, and an evidence base for reducing complications and mortality. Other agents (antiseptics, disinfectants, bacteriophages) are used in limited or specific indications. Clinical effectiveness in the treatment of pleurisy allows you to optimize the choice of antibiotics, ensure economic feasibility and justify the organizational and resource component using the ABC/VED analysis method. The purpose of the study was to summarize clinical and diagnostic guidelines in the treatment of pleurisy. To use an organizational and resource tool to support treatment tactics for pleurisy using the ABC/VED analysis method. To analyze the structure of costs for pharmacotherapy and identify critically necessary items for the continuity of pleurisy treatment. To develop a priority matrix for antibiotic stock management through ABC/VED analysis (allocation of drugs with the greatest contribution to costs and criticality), continuity of procurement, supply and pharmaceutical support considering treatment tactics. To form legal aspects of diagnosis and treatment of pleurisy. Materials and methods For the study, data on annual consumption and costs of antibiotics active against intracellular microorganisms were collected in the period 2020–2025. Clinical and diagnostic guidelines for pleurisy were performed using a complete clinical examination using ultrasound of the pleural cavity, chest radiography, computed tomography, thoracoscopy, videothoracoscopy according to indications. To perform the VED analysis of antibiotics, a multidisciplinary expert commission was involved, which conducted a questionnaire to determine the priority of drugs in the pharmacotherapy of pleurisy. The commission included doctors of various specialties who have practical experience in the management of patients with pleurisy and the prescription of antibacterial drugs. Additionally, a regulatory analysis was carried out based on the inclusion of relevant drugs in the Protocols for the treatment of intracellular infections, the State Formulary of Medicines, and the National List of Essential Medicines [30-32]. The organizational and resource tool for supporting treatment tactics for pleurisy using the ABC/VED method included ABC analysis and VED 39 P.- Annals of Mechnikov Institute. 2025. N 4 www.imiamn.org.ua /journal.htm DOI: 10.5281/zenodo.17923074 analysis. The ABC analysis method is based on the classification of antibiotics by cost. Category A drugs account for about 70% of the total cost of consumption, category B - about 20%, and category C - only 10%. However, this approach has certain limitations, since it is based solely on financial indicators and does not consider the criticality of continuity of supply, purchases and pharmaceutical support considering treatment tactics. To overcome this drawback, VED analysis was used, which classifies drugs by their degree of importance: vital, essential, and desirable. The loss of vital drugs can critically affect the effectiveness of medical care, while the shortage of desirable drugs will not lead to significant complications in the work of the institution. The combination of ABC and VED analyses (ABC-VED matrix) allows to determine priority groups of antibiotics for control and rational use. The ABC-VED methodology contributes to the continuity of purchases, supply, pharmaceutical provision, and to increasing the effectiveness of treatment tactics for pleurisy. ABC-analysis Annual costs for individual drugs were arranged in descending order. The total cost of all drugs was calculated, as well as their percentage contribution to total costs. The resulting list was divided into three categories: • Category A – antibiotics that account for approximately 70% of the total cost of consumption; • Category B – drugs that account for about 20% of costs; • Category C – antibiotics with the lowest cost (about 10%). VED-analysis The assessment of the criticality of antibiotics was carried out by classifying drugs into three groups: vital (V), necessary (E), and desirable (D). To determine the criticality of antibiotics, the following was conducted: • a survey of doctors involved in the pharmacotherapy of patients with intracellular infections; • a normative analysis based on their inclusion in the Protocols for the treatment of intracellular infections, the State Formulary of Medicines and the National List of Essential Medicines. Group V includes drugs that are critically important for the treatment of patients and must be available at any time. Group E includes drugs whose absence in a short period will not lead to serious complications. Group D includes antibiotics with the least criticality, the absence of which will not have a significant impact on the treatment process. The final distribution of antibiotics by VED categories was discussed by an expert group consisting of physicians, pulmonologists, surgeons, pediatricians, and clinical pharmacists. ABC-VED matrix analysis For a comprehensive assessment, cross-analyzing ABC and VED formed an ABC-VED matrix. The resulting combinations allowed us to distinguish three categories: • Category I – vital and expensive antibiotics (AV, AE, AD, BV, CV); • Category II – other critically needed drugs of average cost (BE, CE, BD); • Category III – desirable and less expensive antibiotics (CD). In this classification, the first letter indicates the category according to ABC analysis, and the second – according to VED analysis. The results obtained allow us to determine the priority groups of antibiotics for controlling their consumption and procurement in medical institutions. The obtained data were systematized and entered to Microsoft Excel spreadsheet. Statistical analysis was carried out using the built-in statistical functions of Microsoft Excel. The study of the article is a fragment of research works of of Private Scientific Institution "Scientific and Research University of Medical and Pharmaceutical Law" and Danylo Halytsky Lviv National Medical University on the topic "Diagnosis, treatment, pharmacotherapy of inflammatory, traumatic and onco-thoracic pathology using instrumental methods" (state registration number 0125U000071, implementation period 2025-2031); Private Scientific Institution "Scientific and Research University of Medical and Pharmaceutical Law" and Scientific Research Establishment of Innovations for Future LLC USA on the topic “Multimodal research on innovative legal, medical and pharmaceutical, clinical and pharmacological, behavioral-cognitive, psychological, socio-economic, medical and technological, forensic and pharmaceutical, and digital strategies for patient-centered pharmacotherapy of PTSD and associated diseases in war and conflict settings” (state registration number 0125U003297, implementation period 2025-2029); Private Scientific Institution "Scientific and Research University of Medical Pharmaceutical Law" on the topic "Multidisciplinary research of post-traumatic stress disorders during war among patients (primarily combatants)" (state registration number 0124U002540, implementation period 2024-2029); Lviv Medical Institute on the topic of "Improving the system of circulation of drugs during pharmacotherapy on the basis of evidentiary and forensic pharmacy, organization, technology, biopharmacy and pharmaceutical law" (state registration number 0120U105348, implementation period 20212026). Results In clinical practice of pleurisy, there is often a need to quickly determine where antibiotics are mandatory (bacterial pleurisy, empyema), and where pharmacotherapy with a minimal role of antibiotics is leading. Clinical diagnostic guidelines and treatment tactics in this context mean avoiding unjustified prescription, choosing antibiotics with the best benefitrisk-cost ratio, and ensuring continuous access to priority positions through ABC/VED analysis. Clinical diagnostic guidelines of pleurisy Intracellular microorganisms are pathogens of a wide range of infectious diseases, which complicates their diagnosis and treatment. Intracellular microorganisms can be involved in the formation of pleurisy, mainly as a complication of "atypical" pneumonia or systemic infections. A feature of these pathogens is the ability to 40 P.- Annals of Mechnikov Institute. 2025. N 4 www.imiamn.org.ua /journal.htm DOI: 10.5281/zenodo.17923074 survive and multiply inside the cells of the macroorganism, which significantly reduces the effectiveness of many traditional antibacterial drugs. Intracellular (atypical) pathogens of pleurisy: Legionella, Chlamydophila, Coxiella, Brucella Legionella pneumophila is a common "atypical" cause of pneumonia with exudative, usually small pleural effusion. Diagnosis is based on antigen in urine Polymerase Chain Reaction (PCR) from respiratory material. Requires antibiotics with good intracellular activity (macrolides, fluoroquinolones). When pleurisy complicates to empyema, there is a need to combine with drainage. Chlamydophila (Chlamydia) pneumoniae - can cause small exudative effusions in pneumonia. Diagnosis is mainly Polymerase Chain Reaction (PCR). Treatment: doxycycline, macrolides. Constant monitoring of clinical dynamics and volume of effusion. Coxiella burnetii (tick-borne "Q-fever" infection) is a rare but described cause of pleurisy. Especially against the background of atypical pneumonia or myocarditis. Diagnosis: serology (phase antibodies). Treatment tactics - usually doxycycline. In chronic forms - other schemes according to infection protocols. Brucella - a rare cause of pleurisy. Diagnosis – serological. Treatment tactics – schemes with doxycycline in combinations. The clinical and diagnostic landmarks of pleurisy are given in Fig. 1. Note * Light’s criteria (three laboratory signs from pleural fluid and blood that help distinguish exudate (inflammatory, infectious, e.g., pleurisy, empyema) from transudate (due to “breakdown” of fluid metabolism, e.g., heart failure); ** criteria for immediate drainage (pus, pH <7.20, respiratory failure). Fig. 1. Clinical and diagnostic guidelines for pleurisy . Gautam J. et al. emphasize that in Chlamydia pneumoniae infections (an intracellular pathogen), pleural effusions are a common concomitant manifestation, with chest pain that worsens with breathing (pleural pain) cough chills dyspnea fever intoxication hospitalization operation trauma malignant neoplasms Pulmonary Thromboembolis m pancreatitis ultrasound diagnostics radiography computed tomography Light's criteria* microbiology (cultures) criteria for immediate drainage** 41 P.- Annals of Mechnikov Institute. 2025. N 4 www.imiamn.org.ua /journal.htm DOI: 10.5281/zenodo.17923074 typical diagnostic difficulties. Treatment involves drugs with intracellular activity (doxycycline, macrolides) [27].For pleurisy, this has clinically important consequences: diagnostic tests for common extracellular bacteria are often insensitive (pleural fluid culture may be negative), and empirical antibacterial therapy must consider the penetration of the antibiotic into host cells. Rello J. et al. describes the intracellular nature of Legionella, diagnostic approaches, and recommendations for antibiotics with proven intracellular permeability (macrolides, fluoroquinolones) [26]. Treatment tactics for pleurisy Antibiotic therapy for pleurisy is combined with adequate drainage of the infected pleural cavity. The duration of treatment is usually 2-4 weeks. Switching from parenteral to oral forms of antibiotics is possible after clinical stabilization and a decrease in inflammation. Principles of antimicrobial stewardship – minimizing unnecessary prescriptions, shorter effective courses, reliance on culture, and de-escalation are integrated into the management algorithm. Therefore, the choice antibiotic therapy requires considering not only the spectrum of action of the drug, but also its ability to penetrate cells and create therapeutic concentrations there. The group of antibiotics in the treatment of pleurisy includes drugs of various clinical and pharmacological groups (table 1). Erythromycin (macrolides), doxycycline (tetracyclines), benzylpenicillin (β-lactam antibiotics) and cephalexin (first-generation cephalosporins). Their effectiveness is due to the ability to penetrate target cells and affect intracellular pathogens, such as Chlamydia species pluralis., Legionella species pluralis. and others. Organizational and resource support for clinical decisions (ABC/VED methodology) For further ABC and VED analysis, the following clinical and pharmacological groups of antibiotics were considered (table 1): • Macrolides: erythromycin, spiramycin; • Tetracyclines: doxycycline; • Beta-lactam antibiotics: penicillin G (benzylpenicillin); • First-generation cephalosporins: cephalexin. The distribution of these antibiotics by ABC and VED categories allowed us to determine their economic significance and clinical importance, which is the basis for inventory management, continuity of supply, and procurement in healthcare institutions. Table 1 below shows the characteristics of the studied antibiotics, including dosage form, composition, manufacturer, and registration certificate. Table 1. Clinical and pharmacological groups of antibiotics for the treatment of pleurisy. No. Name Dosage form Composition Manufacturer Registration certificate Macrolides: erythromycin, spiramycin 1. Erythromycin (Borshchahivsky CPP) pills 100 mg Public Joint Stock Company "Scientific and Production Center "Borshchagov Chemical and Pharmaceutical Plant", Ukraine UA/3701/01/01 unlimited from 13.05.2020 2. Zinerit powder 40 mg/ml LEO Pharma A/S, Denmark UA/4359/01/01 unlimited from 17.01.2017 3. Erythromycin (Vitamins JSC) pills 100 mg VITAMINS JSC, Ukraine UA/8709/01/01 unlimited from 15.06.2018 4. Doramycine pills 3 000 000 IU WORLD MEDICINE ILAC SAN. VE TIG. A.Sh., Turkey UA/14899/01/01 unlimited from 26.01.2021 5. Spiracin 3 000 000 IU pills 3 000 000 IU Simpex Pharma Pvt. Ltd., India UA/17331/01/02 04.04.2019 04.04.2025 6. Spiracin 1 500 000 IU pills 1 500 000 IU Simpex Pharma Pvt. Ltd., India UA/17331/01/01 04.04.2019 04.04.2025 7. Rovamycin 1 500 000 IU pills 1 500 000 IU SANOFI S.R.L., Italy UA/6053/01/01 unlimited from 03.02.2021 8. Rovamycin 3 000 000 IU pills 3 000 000 IU SANOFI S.R.L., Italy UA/6053/01/02 unlimited from 03.02.2021 Tetracyclines: doxycycline 9. DoxycyclineDarnitsa capsules 100 mg PrJSC "Pharmaceutical Firm "Darnitsa", Ukraine UA/8028/01/01 unlimited from 03.01.2018 42 P.- Annals of Mechnikov Institute. 2025. N 4 www.imiamn.org.ua /journal.htm DOI: 10.5281/zenodo.17923074 No. Name Dosage form Composition Manufacturer Registration certificate 10. Doxycycline hydrochloride capsules 100 mg Limited Liability Company "Kharkiv Pharmaceutical Enterprise "Health of the People", Ukraine; Limited Liability Company "PHARMEX GROUP", Ukraine; Limited Liability Company "Pharmaceutical Company "Health", Ukraine UA/1307/01/01 unlimited from 03.04.2019 11. DoxycyclineTeva tablets 100 mg Merkle GmbH, Germany UA/3033/02/01 unlimited from 28.04.2021 12. Unidox Solutab tablets 100 mg Astellas Pharma Europe B.V., Netherlands UA/4694/01/01 unlimited from 29.07.2022 13. Doxycycline capsules 100 mg Public Joint Stock Company "Research and Production Center "Borshchagov Chemical and Pharmaceutical Plant", Ukraine UA/3292/01/01 unlimited from 17.12.2019 Beta-lactam antibiotics: penicillin G (benzylpenicillin) 14. Benzylpenicillin 1 000 000 IU powder for solution for injection 1 000 000 IU PJSC "Kyivmedpreparat", Ukraine UA/3791/01/02 unlimited from 21.04.2015 15. Benzylpenicillin 500 000 IU powder for solution for injection 500 000 IU PJSC "Kyivmedpreparat", Ukraine UA/3791/01/01 unlimited from 25.02.2020 16. Penicillin G sodium salt Sandoz powder for solution for injection 1 000 000 IU Sandoz GmbH-TechOps, Austria UA/3977/01/01 unlimited from 17.01.2017 17. Bicillin-3 powder for suspension for injection 600 000 IU PJSC "Kyivmedpreparat", Ukraine UA/3883/01/01 unlimited from 19.08.2015 18. Bicillin-5 powder for suspension for injection 1 500 000 IU PJSC "Kyivmedpreparat", Ukraine UA/3883/01/02 unlimited from 01.09.2015 First-generation cephalosporins: cephalexin 19. Cephalexin Alkaloid powder for oral suspension 250 mg ALKALOID AD Skopje, Republic of North Macedonia UA/0264/01/01 unlimited from 16.01.2021 20. Cephalexin suspension granules for oral suspension 250 mg "Hemofarm" AD, Serbia; Hemomont d.o.o., Montenegro UA/7888/01/01 unlimited from 22.02.2019 21. Cephalexin capsules capsules 250 mg Public Joint Stock Company "Scientific and Production Center "Borshchagov Chemical and Pharmaceutical Plant", Ukraine UA/6034/01/01 unlimited from 13.05.2017 Table 1 contains information on antibiotics, divided into clinical and pharmacological groups. Includes 21 drugs belonging to four main clinical and pharmacological groups: 1. Macrolides (erythromycin, spiramycin) – 8 drugs available in the form of tablets and powders for the preparation of a solution for external use. 2. Tetracyclines (doxycycline) – 5 drugs in the form of capsules and tablets. 3. Beta-lactam antibiotics (penicillin G, benzylpenicillin) – 5 drugs in the form of powders for the preparation of a solution for injection. 4. First-generation cephalosporins (cephalexin) – 3 drugs in the form of powders for suspension and capsules. For each drug, its trade name, dosage form, composition of the active substance, manufacturer and registration certificate in Ukraine are indicated. All drugs have valid licenses and registrations, confirming their availability for medical use. The cost structure, priority of pharmaceutical provision and use in medical institutions according to clinical scenarios are the basis for further analysis and distribution of antibiotics according to ABC-VED categories. 43 P.- Annals of Mechnikov Institute. 2025. N 4 www.imiamn.org.ua /journal.htm DOI: 10.5281/zenodo.17923074 In this article, the analysis of costs and criticality of drugs is considered as an auxiliary management tool that ensures the implementation of clinical algorithms for the treatment of pleurisy. It does not replace the clinic, but strengthens it: it identifies groups of continuity of supply, reduces the risks of treatment delays, and supports a reasonable choice of drug in situations of shortage. ABC analysis Table 2 presents the distribution of antibiotics by ABC categories based on their cost and share in total costs. Antibiotics are divided into three categories depending on their share in total costs for medicines: • Category A includes drugs that make up 70% of the total cost of consumption. These are the most expensive antibiotics. • Category B covers drugs that account for 20% of costs. • Category C includes drugs with the lowest specific weight, up to 10% of the total cost. This classification allows a clear assessment of the impact of each group of antibiotics on total costs and simplifies the analysis of drug costs. Table 2. ABC analysis of antibiotics for the treatment of pleurisy. Table 2 contains information about drugs divided into three categories (A, B, C) depending on their cost and share in total expenditures. Here is the analysis of the data by categories: 1. Category A (highest expenditures): • This category includes the most expensive drugs, accounting for 71.33% of total expenditures (1 738.64 UAH). • Category A drugs include such medications as Doramycine (297.72 UAH), Rovamycin 3 000 000 IU (288.37 UAH), Unidox Solutab (255.60 UAH), Spiracin 3 000 000 IU (240.90 UAH), and others. No. Name of the medicinal product Dosage form Cost, UAH Specific gravity (%) Category ABC 1. Doramycine pills 297,72 12,21 А 2. Rovamycin 3 000 000 IU pills 288,37 11,83 А 3. Unidox Solutab tablets 255,60 10,49 А 4. Spiracin 3 000 000 IU pills 240,90 9,88 А 5. Zinerit powder 150,00 6,15 А 6. Bicillin-5 powder for suspension for injection 137,90 5,66 А 7. Cephalexin Alkaloid powder for oral suspension 124,40 5,10 А 8. Rovamycin 1 500 000 IU pills 122,85 5,04 А 9. Doxycycline-Teva tablets 120,90 4,96 А Total by category A 1738,64 71,33 10. Spiracin 1 500 000 IU pills 120,80 4,96 В 11. Cephalexin suspension granules for oral suspension 120,30 4,94 В 12. Bicillin-3 powder for suspension for injection 108,00 4,43 В 13. Cephalexin capsules capsules 100,50 4,12 В Total by category B tablets JSC "Vitamins" 449,6 18,44 Total by categories AB: capsules 2188,24 89,77 14. Erythromycin (Borshchahivsky CPP) pills 65,00 2,67 С 15. Doxycycline-Darnitsa capsules 48,30 1,98 С 16. Erythromycin (Vitamins JSC) pills 38,90 1,60 С 17. Doxycycline capsules 30,16 1,24 С 18. Penicillin G sodium salt Sandoz powder for solution for injection 22,90 0,94 С 19. Doxycycline hydrochloride capsules 21,85 0,90 С 20. Benzylpenicillin 1 000 000 IU powder for solution for injection 13,85 0,57 С 21. Benzylpenicillin 500 000 IU powder for solution for injection 8,40 0,34 С Total by category C: 249,36 10,23 Total by categories ABC: 2437,6 100,00 44 P.- Annals of Mechnikov Institute. 2025. N 4 www.imiamn.org.ua /journal.htm DOI: 10.5281/zenodo.17923074 • These drugs have high costs and are widely used, which determines their high share in total expenditures. 2. Category B (medium expenditures): • Drugs in this category account for 18.44% of total expenditures (449.6 UAH). • They are slightly cheaper than Category A drugs but still play a significant role in treatment. Examples in this group include Spiracin 1 500 000 IU (120.80 UAH) and Cephalexin suspension (120.30 UAH). 3. Category C (lowest expenditures): • Drugs in this category account for only 10.23% of total expenditures (249.36 UAH). • These are the least expensive medications. For example, Erythromycin (Borshchahivsky CPP) (65.00 UAH), Doxycycline-Darnitsa (48.30 UAH), and Erythromycin (Vitamins JSC) (38.90 UAH). • These drugs are less costly, making them more accessible, but they have the smallest share in total expenditures. The total cost of all antibiotics is 2 437.60 UAH, which includes expenditures on drugs from all three categories (A, B, C). VED analysis For further research and VED analysis of antibiotics, a multidisciplinary committee was surveyed to determine the priority of drugs for pharmacotherapy. This survey included doctors of various specialties who have experience in the treatment of pleurisy and the prescription of antibiotics. Normative analysis data were also used based on their inclusion in the treatment protocols for intracellular infections, the State Formulary of Medicines, and the National List of Essential Medicines. According to the survey results, doctors classified antibiotics into VED categories: • V (Vital) – drugs that are critically important for therapy and are used in severe or potentially life-threatening conditions; • E (Essential) – drugs that are used to treat most diseases, but are not mandatory for the treatment of every case; • D (Desirable) – drugs that are rarely used and are less important compared to other drugs. The data obtained because of this analysis are the basis for prioritizing the use of antibiotics in practice and optimizing pharmacotherapy (table 3) Table 3. VEDanalysis of antibiotics for the treatment of pleurisy. Table 3 presents antibiotics, distributed by VED categories: Category V (Vital): Doxycycline, DoxycyclineDarnitsa, Doxycycline-Teva, Doxycycline hydrochloride, Erythromycin (Vitamins JSC), Erythromycin (Borshchahivsky CPP), Cephalexin capsules, Unidox Solutab. Category E (Essential): Benzylpenicillin 1,000,000 IU, Benzylpenicillin 500,000 IU, Bicillin-3, Bicillin-5, Penicillin G sodium salt Sandoz, Cephalexin suspension, Cephalexin Alkaloid. Category D (Desirable): Doramycine, Zinerit, Rovamycin 1,500,000 IU, Rovamycin 3,000,000 IU, Spiracin 3,000,000 IU, Spiracin 1,500,000 IU. This division of drugs into categories allows you to optimize pharmacotherapy by identifying the most important drugs for the treatment of patients with pleurisy. The specific weight of each category and the list of drugs in it are shown in Fig. 1. No. Name of the medicinal product Dosage form VED category 1. Doxycycline capsules V 2. Doxycycline-Darnitsa capsules V 3. Doxycycline-Teva tablets V 4. Doxycycline hydrochloride capsules V 5. Erythromycin (Vitamins JSC) pills V 6. Erythromycin (Borshchahivsky CPP) pills V 7. Cephalexin capsules capsules V 8. Unidox Solutab tablets V 9. Benzylpenicillin 1 000 000 IU powder for solution for injection Е 10. Benzylpenicillin 500 000 IU powder for solution for injection Е 11. Bicillin-3 powder for suspension for injection Е 12. Bicillin-5 powder for suspension for injection Е 13. Penicillin G sodium salt Sandoz powder for solution for injection Е 14. Cephalexin suspension granules for oral suspension Е 15. Cephalexin Alkaloid powder for oral suspension Е 16. Doramycine pills D 17. Zinerit powder D 18. Rovamycin 1 500 000 IU pills D 19. Rovamycin 3 000 000 IU pills D 20. Spiracin 3 000 000 IU pills D 21. Spiracin 1 500 000 IU pills D 45 P.- Annals of Mechnikov Institute. 2025. N 4 www.imiamn.org.ua /journal.htm DOI: 10.5281/zenodo.17923074 Fig. 2. Distribution according to the results of VED analysis of the studied antibiotics for the treatment of pleurisy Matrix of priorities for antibiotic stock management, obtained by ABC/VED analysis Based on the ABC/VED analysis, a matrix of priorities for antibiotic stock management was developed, considering clinical scenarios for the treatment of pleurisy (Fig. 3). Drug categories Number of drugs V Number of drugs Е Number of drugs D Prescription of drugs Prescription of drugs Prescription of drugs UAН % UAН % UAН % А 2 376,50 15,44 2 262,3 10,76 5 1099,84 45,12 В 1 100,50 4,12 2 228,3 9,37 1 120,80 4,97 С 5 204,21 8,37 3 45,15 1,85 - - - Together: 8 681,21 27,93 7 535,75 21,98 6 1220,64 50,09 Fig. 3. Priority matrix for antibiotic stock management through ABC/VED analysis of antibiotics for the treatment of pleurisy. The conducted studies (Table 4) show that: • For category A, the share of costs fell on groups A/V — 15.44%, A/E — 10.76% and A/D — 45.12%. This category included drugs such as Unidox Solutab, Bicillin-5, Doramycine. • Category B was characterized by B/V — 4.12%, B/E — 9.37% and B/D — 4.97%. Cephalexin capsules, Cephalexin suspension were included in this category. • Category C demonstrated shares of C/V — 8.37%, C/E — 1.85%, costs for C/D were not recorded. Examples of drugs in this group are Erythromycin (Borshchahivsky CPP), Penicillin G sodium salt Sandoz. Table 4. ABC/VED analysis of antibiotics for the treatment of pleurisy (examples of drugs). V E D А Unidox Solutab Doxycycline-Teva Bicillin-5 Cephalexin Alkaloid Doramycine Rovamycin 3 000 000 IU Spiracin 3 000 000 IU Zinerit Rovamycin 1 500 000 IU В Cephalexin capsules Cephalexin suspension Bicillin-3 Spiracin 1 500 000 IU С Erythromycin (Borshchahivsky CPP) Doxycycline-Darnitsa Erythromycin (Vitamins JSC) Doxycycline Doxycycline hydrochloride Penicillin G sodium salt Sandoz Benzylpenicillin 1 000 000 IU Benzylpenicillin 500 000 IU - V (Vital): 38.10% E (Essential): 33.33% D (Desirable): 28.57% •Doxycycline, Doxycycline-Darnitsa, Doxycycline-Teva, Doxycycline hydrochloride, Erythromycin (Vitamins JSC), Erythromycin (Borshchahivsky CPP), Cephalexin capsules, Unidox Solutab •Benzylpenicillin 1 000 000 IU, Benzylpenicillin 500 000 IU, Bicillin-3, Bicillin-5, Penicillin G sodium salt Sandoz, Cephalexin suspension, Cephalexin Alkaloid •Doramycine, Zinerit, Rovamycin 1 500 000 IU, Rovamycin 3 000 000 IU, Spiracin 3 000 000 IU, Spiracin 1 500 000 IU 46 P.- Annals of Mechnikov Institute. 2025. N 4 www.imiamn.org.ua /journal.htm DOI: 10.5281/zenodo.17923074 The share of antibiotic costs by VED category is shown in Fig. 4, which illustrates the distribution of priority and economic burden of drugs in the clinical practice of treating pleurisy. Fig. 4. Share of antibiotic costs in VED categories. The combination of clinical and diagnostic guidelines, treatment tactics, priority matrix for inventory management, procurement, supply, pharmaceutical support allows to reduce unjustified prescriptions, minimize supply disruptions at critical points of treatment and support the decisions of formulary and procurement committees. ABC/VED here acts as an organizational and resource tool to support treatment tactics for pleurisy. Legal principles of diagnosis and treatment of pleurisy Legal support for the diagnosis and treatment of pleurisy is based on the principles of legality, evidencebased medicine, patient safety, professional responsibility of medical professionals and respect for human rights in the field of health care. The use of medical interventions for pleurisy requires not only clinical feasibility, but also strict adherence to regulatory requirements, information procedures, documentation, traceability, and ethical standards. Informed consent and risk communication The patient must receive complete, understandable information about the purpose, methods, possible alternatives, expected results, typical risks (pneumothorax, bleeding, infectious complications, pain syndrome, bronchopleural fistula), as well as about possible complications of anesthesia. The consent is drawn up in writing in the presence of the medical professional performing the procedure. In urgent situations, a simplified form is allowed with subsequent expanded information. For minors or persons with limited legal capacity, written consent of a legal representative is required, considering the patient's interests. Clinical indications and standards of medical care Medical interventions (puncture, drainage, antibiotic therapy, surgical treatment) are performed in accordance with national protocols and standards of medical care. Doctors performing manipulations must have appropriate qualifications, certification, and proven competence. The medical institution is obliged to ensure the availability of certified equipment, a sterility control system, metrological supervision, as well as algorithms for responding to complications. Laboratory diagnostics and sample circulation Pleural fluid collection, labeling, transportation, and storage are carried out in accordance with the Standard Operating Procedure. Protocols must indicate the purpose of the procedure, responsible persons, a list of materials, stages