site.btaExperts Create Interactive Map of Antibiotic Consumption in Bulgaria

Experts created an interactive map of antibiotic consumption in Bulgaria and discussed the topic of antibiotic resistance during a news conference at BTA’s national press club in Sofia on Monday. The conference also addressed the rational and irrational antibiotic consumption and its impact on resistance. The map presents National Health Information System (NHIS) and National Statistical Institute (NSI) data about prescriptions and prescribed antibiotic packages.

The purpose of the map is to raise public awareness of the urgent need for action, said Dragomir Ivanov, MD, President of the One Health Bulgarian Association. He added that although antibiotic resistance might not initially affect patients or their families, they could encounter drug-resistant microorganisms if admitted to hospital.

Once antibiotic resistance occurs, it spreads rapidly, while restoring antibiotic susceptibility is a very slow process, said Prof. Emma Keuleyan, head of the Laboratory of Microbiology, Virology and Hospital Hygiene at Lozenets University Hospital and Health Ministry coordinator. She also added that antibiotic-resistant infections kill around 700,000 people worldwide each year and cost Europe and the US billions of euros and dollars, respectively.

Resistance emerges in hospital intensive care units, where severely ill patients require powerful, broad-spectrum antibiotics that exert strong selective pressure, allowing resistant bacteria to multiply and spread rapidly, with resistance transferable between bacterial cells within 20 minutes.
Prof. Keuleyan said that in outpatient care, antibiotics should also be prescribed rationally, only for confirmed or strongly suspected bacterial infections, and recommended delayed antibiotic prescribing by general practitioners.

Rational antibiotic use means prioritizing antibiotics proven to result in lower resistance rates and less selective pressure on bacteria, Assoc. Prof. Ivan Ivanov, head of the National Reference Laboratory and member of One Health Bulgarian Association explained. He added that national guidelines should be developed for outpatient care to regulate the rational use of antibiotics. He also noted a positive trend in overall antibiotic use, which fell by 20% in 2025 and, according to preliminary data, by a further 10-15% in 2026.

Bulgarian Pharmaceutical Union President Dimitar Marinov said that actual antibiotic sales should match prescriptions and dispensing data, but they do not, as sales are higher. He said that the process needs to be monitored to prevent such inconsistencies. Pharmacies now refuse to sell antibiotics without an e-prescription, but patients buy them from neighbouring countries or grocery stores, constituting illegal imports, he added. Marinov urged patients to obtain antibiotics only from pharmacies and not online.

Asked about antibiotic use in animals, he said veterinary medicine still faces major challenges, as the distribution and prescribing of antibiotics are not sufficiently traceable. A system to regulate antibiotic prescribing is reportedly being developed, he added, noting that access to antibiotics among livestock farmers is particularly broad. Prof. Keuleyan said that 80% of antibiotic use is linked to livestock farming, with a smaller share involving pets.