By Reneta Ilieva, Bulgarian Association for Patients’ Rights Defence 

For several months, Bulgarian authorities have been advising practitioners not to prescribe antibiotics for COVID-19, but no significant progress has been achieved in terms of fighting antibiotic resistance in a broader sense – in a systemic way, at the societal scale.  

Especially during the cold and flu seasons, oftentimes patients self-medicate or doctors prescribe broad-spectrum antibiotics ‘blindly’ – that is, without performing a microbiological test to guide them as to what is the best course of action. Through an ‘expedite procedure’, this test can be completed within 36 hours (rather than 72 hours, the standard time) – but not many are aware of this option.  

According to information obtained by the Bulgarian Association for Patients’ Rights Defence, some hospital directors have calculated that it is cheaper for them to pay about 8 euros to have an antibiogram done on all suspected cases where an antibiotic is to be given than to give more expensive antibiotics later on, or to cover the costs of other complications, which may rise to hundreds of thousands of Bulgarian leva (BGN). The issue of hospital-acquired infections (HAIs) is not receiving the attention it should, but legal action by patients and their families may be one tool to raise awareness and mobilise the management of medical institutions to implement plans against antimicrobial resistance.  

Health authorities, such as “Regional Health Inspections” publish quarterly information on bacteria that are nosocomial infections in medical facilities, but according to experts speaking with Bulgarian Association for Patients’ Rights Defence, who are infectious disease specialists or from laboratories, the published cases significantly below the real incidence. 

Currently, Bulgaria does not have the necessary equipment – machines to automate culture for microbiological research, which would increase the possibility of performing preliminary screening or diagnosis of bacterial infections, including in cases where an emergency diagnosis is required.  

The health authorities, even during the Antimicrobial Resistance Awareness Week, do not analyse the change in the situation in Bulgaria and whether there is a positive direction, but simply make a declarative wish that attention be paid to antimicrobial resistance in pre-hospital and hospital care. 

We, the Bulgarian Association for Patients’ Rights Defence, call for no unnecessary use of antibiotics because this increases antibiotic resistance. There is no need for antibiotics to be prescribed for ordinary uncomplicated viral infections. Antibiotics should be prescribed after an antibiogram – that is, when relevant bacteria and their sensitivity are proven. Finally, patients themselves should not self-medicate, and strong policies should be in place to avoid this type of mis- and over-use of antibiotics. 

Disclaimer: the opinions – including possible policy recommendations – expressed in the article are those of the author and do not necessarily represent the views or opinions of EPHA. The mere appearance of the articles on the EPHA website does not mean an endorsement by EPHA. 

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