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

• Published in: The Lancet infectious diseases Vol. 8; no. 2; pp. 125 - 132
• Main Authors: Mölstad, S, Prof, Erntell, M, MD, Hanberger, H, MD, Melander, E, MD, Norman, C, MD, Skoog, G, MScPharm, Lundborg, C Stålsby, Prof, Söderström, A, MD, Torell, E, MD, Cars, O, Prof
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 2008; Lancet Publishing Group; Elsevier Limited
• Subjects: Adolescent; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotic resistance; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimicrobial agents; Bacteria - drug effects; Biological and medical sciences; Child; Child, Preschool; Clinical Medicine; Drug Resistance, Bacterial; Drug Utilization - statistics & numerical data; Hospitalization - statistics & numerical data; Humans; Infectious Disease; Infectious diseases; Infectious Medicine; Infektionsmedicin; Infektionssjukdomar; Klinisk medicin; Medical and Health Sciences; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Microbiology, immunology, infectious diseases; Mikrobiologi, immunologi, infektionssjukdomar; Pharmacology. Drug treatments; Pneumococcal Infections - drug therapy; Pneumococcal Infections - epidemiology; Pneumococcal Infections - microbiology; Pneumococcal Infections - prevention & control; Population Surveillance - methods; Program Evaluation; Respiratory Tract Infections - drug therapy; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - microbiology; Respiratory Tract Infections - prevention & control; Sweden - epidemiology; Sweden; Europe; Infection; Resistance; Bacteriosis; Antibacterial agent; Medical prescription
• ISSN: 1473-3099; 1474-4457; 1474-4457
• DOI: 10.1016/S1473-3099(08)70017-3

Summary Increasing use of antibiotics and the spread of resistant pneumococcal clones in the early 1990s alarmed the medical profession and medical authorities in Sweden. Strama (Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of 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.