Lessons learnt during 20 years of the Swedish strategic programme against antibiotic resistance

Abstract

Increasing use of antibiotics and rising levels of bacterial resistance to antibiotics are a challenge to global health and development. Successful initiatives for containing the problem need to be communicated and disseminated. In Sweden, a rapid spread of resistant pneumococci in the southern part of the country triggered the formation of the Swedish strategic programme against antibiotic resistance, also known as Strama, in 1995. The creation of the programme was an important starting point for long-term coordinated efforts to tackle antibiotic resistance in the country. This paper describes the main strategies of the programme: committed work at the local and national levels; monitoring of antibiotic use for informed decision-making; a national target for antibiotic prescriptions; surveillance of antibiotic resistance for local, national and global action; tracking resistance trends; infection control to limit spread of resistance; and communication to raise awareness for action and behavioural change. A key element for achieving long-term changes has been the bottom-up approach, including working closely with prescribers at the local level. The work described here and the lessons learnt could inform countries implementing their own national action plans against antibiotic resistance.

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…Overall, antibiotic utilisation decreased by 31% between 1999 and 2012 through these multiple initiatives Sweden Sweden has been particularly active over a number of years to improve antibiotic prescribing and reduce AMR 280 . The multiple initiatives, which included educational initiatives among physicians, academic detailing, guidelines including diagnostic criteria for each condition and an analysis of the risk and benefits of antibiotics, instigating local multidisciplinary groups discussing antibiotic prescribing, monitoring antibiotic prescribing and resistance rates including quality targets, patient education, and susceptibility testing, reduced antibiotic prescribing in ambulatory care, including primary care, by 43% between 1992 and 2016, whilst among children 4 years or under the prescribing of antibiotics including those for URTIs decreased by 73% 280 .…”

Change in the use of diagnostic tests in the management of lower respiratory tract infections: a register-based study in primary care

“…It may also have increased the awareness of antibiotic resistance and contributed to increased knowledge. 23,24…”

Prevalence of clarithromycin-resistant Helicobacter pylori in children living in South of Sweden: a 12-year follow-up

“…Antibiotic resistance in Sweden is expected to be low as compared to many other European countries, presumably due to a more restrictive prescription of antibiotics in the general population [1,2]. Clarithromycin is commonly used in the first line antibiotic treatments of Helicobacter pylori (HP) gastritis in Sweden [3][4][5].…”