Sustained reduction of antibiotic use and low bacterial resistance: 10-year follow-up of the Swedish Strama programme

Abstract

Resistance) was therefore started in 1994 to provide surveillance of antibiotic use and resistance, and to implement the rational use of antibiotics and development of new knowledge. Between 1995 and 2004, antibiotic use for outpatients decreased from 15·7 to 12·6 defined daily doses per 1000 inhabitants per day and from 536 to 410 prescriptions per 1000 inhabitants per year. The reduction was most prominent in children aged 5-14 years (52%) and for macrolides (65%). During this period, the number of hospital admissions for acute mastoiditis, rhinosinusitis, and quinsy (peritonsillar abscess) was stable or declining. Although the epidemic spread in southern Sweden of penicillin-resistant Streptococcus pneumoniae was curbed, the national frequency increased from 4% to 6%. Resistance remained low in most other bacterial species during this period. This multidisciplinary, coordinated programme has contributed to the reduction of antibiotic use without measurable negative consequences. However, antibiotic resistance in several bacterial species is slowly increasing, which has led to calls for continued sustained efforts to preserve the effectiveness of available antibiotics.

Anterior rhinoscopy and middle meatal culture in acute rhinosinusitis

“…11,12 To our best knowledge, the present study is the first to correlate culture findings for the nasopharynx, and for the nasal middle meatus sampled via anterior rhinoscopy, with those for the maxillary antrum. The results indicate that bacterial findings for the maxillary antrum correlate slightly better with those for middle meatal secretions than those for the nasopharynx.…”

Antimicrobial Resistance: Are We at the Dawn of the Post-Antibiotic Era?

“…Long term follow up data from a national programme in Sweden showed no correlation between a reduction in outpatient antibiotic prescriptions for respiratory infections and selected complication rates. 27 Recent publications have highlighted the potential benefit of delayed antibiotic strategies in uncomplicated acute respiratory infections in adults. 28,29 These strategies are a compromise between the clinician's desire (and the patient's request) to 'do something' and to allay fears of missing potential complications on the one hand and the goal of reducing the possible consequences of antibiotic misuse on the other.…”

High costs and burden of illness in acute rhinosinusitis: real-life treatment patterns and outcomes in Swedish primary care

“…15 In the current study, we found that antibiotic treatment was common, despite national programmes to reduce its use. 20 The most recent Cochrane update emphasised that antibiotics have a limited treatment effect in acute rhinosinusitis and stated that most cases will resolve without antibiotics within 2 weeks. 21 Our interpretation of the data is that, in contrast to medical evidence and recent guidelines, there still seems to be a general view among GPs that mild to moderate acute rhinosinusitis is the result of a bacterial infection.…”