Bulgaria is risking an increase in deaths directly or indirectly caused by antibiotic-resistant pathogens, following a 27% rise in antibiotic use over the past five years.
The Bulgarian Ministry of Health, which provided the data to Euractiv, is pushing for funding for a targeted programme to inform citizens about the risks of antibiotic overuse.
The problem of antimicrobial resistance (AMR) is covered by Regulation (EU) 2022/2371 of the European Parliament and the Council of the EU on serious cross-border threats to health. Yet Bulgaria is the only country in the Union with such a sharp increase in antibiotic use over the last five years.
Euractiv was told by the Ministry of Health that it has “informed the Ministry of Finance of the need to provide additional funding for a National Action Programme against Antimicrobial Resistance until 2027.”
A steady rise
In Bulgaria, the total use of antibacterials for systemic use in human medicine was 20.7 therapeutic daily doses (TDDs) per 1,000 people in 2019, almost identical to the EU average.
In 2023, 26.3 daily doses of antibiotics per 1,000 people were used in Bulgaria, while the EU average remained 20.09. In percentage, this means an increase of 27% over five years.
The COVID-19 pandemic contributed significantly to the rise in antibiotic consumption. However, use remained high even after the acute phase passed.
Only Greece (28.5%) and Romania (27.4) report higher levels of antimicrobial use. Still, in Greece, there has been a decline over the last five years, while in Romania, levels are stable, and the pandemic wasn’t followed by an increase in consumption.
A working group of experts has already drafted a much-needed National Action Programme against Antimicrobial Resistance. However, the plan has not yet been adopted due to the lack of approved funding.
Gaps in reporting, monitoring
Data from the National Centre for Infectious and Parasitic Diseases show that Bulgaria is experiencing resistance to all classes of antibiotics, including the newest generation of drugs not yet registered in the country, such as cefiderocol, plazomicin and eravacycline.
Although the problem is very serious, Bulgaria lacks a legal framework to classify, register and report deaths associated with infections by resistant microorganisms.
The only exceptions are made for people diagnosed with HIV and tuberculosis.
However, some researchers apply mathematical models to obtain an approximation.
According to the Institute for Health Metrics and Evaluation (IHME) mathematical calculations, in 2019, 1,600 deaths were directly associated with antimicrobial resistance and 6,400 indirectly linked. This means that nearly 8% of deaths in the country can be traced to antimicrobial resistance, which is the third most common cause of death after cardiovascular disease and cancer.
E-restrictions
It was only in 2023 that the Bulgarian Parliament decided to effectively restrict free access to antibiotics in the country by introducing an electronic control system. It links personal doctors to pharmacies, resulting in single-use prescriptions for antibiotic treatment.
Before the introduction of this system, antibiotics could be freely purchased with old prescriptions.
Dr Victoria Chobanova, chairperson of the Association of General Practitioners in Sofia, told Euractiv that the sale of antibiotics has been restricted since the introduction of the electronic system.
“The patients buying the medicines on their own have disappeared. At least in my practice, I see a reduction. This is a positive step for both patients and doctors; it puts an end or at least significantly limits the practice of pharmacists offering antibiotics without people having gone to see a doctor,” Chobanova says.
Responding to a question on why the National Programme on Rational Use of Antibiotics and Antibiotic Resistance is not being adopted, she said the problem lies with pharmacies.
“The problem is not the lack of a national programme, but the lack of control in pharmacies because there is still complete negligence. If there is no control over pharmacies and there is a national programme, you will still be able to buy antibiotics freely,” the doctor claims.
[Edited by Vasiliki Angouridi, Brian Maguire]
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Publish date : 2024-10-31 13:53:00
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