Antimicrobial resistance as a public health challenge seen through a cultural lens

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Introduction: Antibiotics (ABs) are among the most significant scientific discoveries. Their unreasonable use, however, is a leading cause of the development of antimicrobial resistance (AMR) – one of the three most serious health threats for Europe in the 21st century. The aim of this publication is to present the AMR public health challenge through the prism of the cultural specifics of Bulgaria. Materials and Methods: A study was made of the current state of publications in keywords: “health”, “culture”, “Hofstede”, “Bulgaria”, “antibiotics use”, “self-medication”, “patients”, “public health” in PubMed and Google Scholar in August 2024. The up-to-date content of publicly available information related to the consumption of ABs in Bulgaria and the European policies regarding AMR in the period 2022–2024 was studied. Results of studies carried out so far on the consumption of ABs on a national scale are systematized, making a comparative analysis with other European countries. The review presents Hofstede’s model of five cultural dimensions, which was used as an analytical framework for the irrational use of ABs specific to the Bulgarian patient. Results and Discussion: Antibiotic consumption among Bulgarians is more than twice as high as in other European countries, increasing significantly in recent years. The reasons for this are many, but answers are sought here through Hofstede’s model of five cultural dimensions. Conclusion: The cross-cultural approach to the public health challenge of AMR is essential for successful changes in behavioral patterns that lead to irrational use of ABs. The holistic approaches of One Health for humans, animals, and plants remain very important for the sustainable management of AMR.

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