Bulgaria is among the EU countries where antimicrobial resistance (AMR) is rising, said Michele Cecchini, head of the public health division at the Organisation for Economic Co-operation and Development (OECD). He said Bulgaria is likely to be among the countries with the highest AMR by 2035.

Antibiotic use in Bulgaria rose by 8% between 2019 and 2024. Poland, Romania and Greece also have high levels of AMR.

Cecchini presented the data at a forum held by the National Centre of Infectious and Parasitic Diseases. Its full name is the national forum with international participation "Infection prevention and control and antimicrobial resistance in the context of health system management: the One Health approach and cross-sector cooperation".

Cecchini said the figures are high because antibiotics are too often not used as directed. Some 19% of antibiotics prescribed by GPs do not match the guidelines for the drug. If the right steps are taken, about €2m a year could be saved. The most important thing for Bulgaria is to invest in better hygiene in hospitals, he said.

Johan Van Elder, secretary general of the European Alliance of Universities Hospitals, called for fewer antibiotic prescriptions. He is not optimistic. Van Elder said AMR will not go away. It will stay and keep growing.

Van Elder said resistance existed long before antibiotics, but people speed up the arrival of resistant genes. Resistance is picked up very easily and is very hard to remove. Europe is surrounded by regions with very high levels, the highest in Russia, he said. Levels are also very high in China and India, and resistant genes will keep entering Europe.

He said the problem is not only in hospitals. Resistant genes are passing between people more and more, and many patients arrive at hospital already carrying them. Transmission is rising even in Norway and Canada, which have measures against it. Van Elder also cited a World Health Organization report that shows the yearly change in the share of resistance for some of the most important antibiotics. It shows that resistance is rising worldwide.

Prevention and control are the strongest weapon against hospital infections and their spread, Van Elder said. The best thing to do is to improve the education and skills of the workforce.

Prof. Iva Hristova, director of the National Centre of Infectious and Parasitic Diseases, put the focus on preventing infections. She said prevention is the basis of good medical practice and needs many specialists to take part. Hristova called for the problems to be made clear and for concrete steps to be set out to solve them.

The One Health association organised the forum with the support of the Ministry of Health. It aims to bring together institutions, medical facilities, professional, non-governmental and patient groups, academics, industry and other interested parties around shared priorities and action against AMR and for infection prevention under the One Health approach.

The event is part of the National Action Programme against AMR for 2026–2029.