Abstract
The overall aim of Strama (The Swedish Strategic Programme Against Antibiotic Resistance) is to preserve the effectiveness of antibiotics in humans and animals. Strama is organised at two levels: a network of independent local multidis ciplinary groups in each county that provide prescribers with feedback on antibiotic use and resistance and implement guidelines; and a national executive working group funded by the government. To gain an insight into antibiotic use, Strama has conducted several large diagnosis prescribing surveys in primary care, in the hospital settings and in nursing homes. National antibiotic susceptibility data for Sweden and mandatory notification show that in recent years the proportion of Streptococcus pneumoniae with decreased sensitivity to penicillin V has stabilised (around 6 %), but the number of notified cases of meticillin-resistant Staphylococcus aureus (MRSA)has increased and ESBL-producing Enterobacteraceae have turned into an endemic situation. Still, Sweden is among the countries with the lowest rates of MRSA (<1 %), S. pneumoniae can still be treated with penicillin V and the rate of Escherichia coli-producingESBLs is below 5 %. Strama's activities have contributed to a steady decrease in antibiotic use from the mid 1990s until 2004(when total use slowly started to increase again) without measurable negative consequences. Regular collaboration with national and regional news media has been one of the key strategies.
Highlights
Increasing use of antibiotics and spread of penicillin-resistant pneumococcal clones in the beginning of the 1990s alarmed the medical profession and authorities in Sweden
Strama is organised at two levels: local groups in each county and a national executive working group funded by the government
Sweden is among the countries with the lowest rates of meticillin-resistant Staphylococcus aureus (MRSA), S. pneumoniae can still be treated with penicillin V and the rate of Escherichia coli-producing extended-spectrum betalactamases (ESBLs) is below 5 %
Summary
Increasing use of antibiotics and spread of penicillin-resistant pneumococcal clones in the beginning of the 1990s alarmed the medical profession and authorities in Sweden. A survey of hospital admissions recorded in the national registry of diagnosis in hospital care, showed no increase in the number of patients with acute sinusitis, quinsy and acute mastoiditis despite the reduction in antibiotic prescriptions for children between 1987 and 2003 [20] Continuous systems for such monitoring need to be implemented. Sweden is among the countries with the lowest rates of MRSA (still below 1 %), S. pneumoniae can still be treated with penicillin V and the rate of Escherichia coli-producing ESBLs is below 5 %
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