Sustained reduction of antibiotic use and low bacterial resistance. A ten-year follow-up of the Swedish Strama programme

Abstract number: 1732_99

Mölstad S., Erntell M., Hanberger H., Melander E., Norman C., Skoog G., Stålsby Lundborg C., Söderström A., Torell E., Cars O.

Objectives: Increasing use of antibiotics and spread of resistant pneumococcal clones in the beginning of the 90ies alarmed the medical profession and medical authorities in Sweden. A coordinated effort to prevent further spread and preserve the effectiveness of antimicrobial agents was therefore initiated

Methods: Strama (The Swedish strategic programme for the rational use of antimicrobial agents and surveillance of resistance) was initiated in 1994. The Strama network includes a broad representation of medical disciplines, professional organisations and relevant authorities. The programme includes surveillance of antibiotic use and resistance, implementation of rational use of antibiotics and development of new knowledge. The main goal is to preserve the effectiveness of antimicrobial agents.

Results: Yearly validated data on antibiotic use and resistance were made publicly available on a website. Multidisciplinary Strama-groups were formed in each county to disseminate knowledge and implement rational antibiotic use. Studies were performed on indications for antibiotic use in out-patient care, hospital care and nursing homes.

Between 1995 and 2004 antibiotic use for out-patients decreased from 15.7 to 12.6 DDD/TID and from 536 to 410 prescriptions per 1000 inhabitants and year. The reduction was most prominent for children 5–14 years old (52%) and for macrolides (65%). During the period, the number of hospital admissions for acute mastoiditis, rhinosinusitis and quinsy was stable or declining. Although the epidemic spread in southern Sweden of penicillin-resistant S. pneumoniae was curbed, the national frequency increased from 4% to 6%. A hospital outbreak of MRSA could be terminated using aggressive infection-control measures. Resistance remained low in most other bacterial species during the period.

Conclusions: This multidisciplinary, coordinated programme has contributed to the reduction of antibiotic use without measurable negative consequences. Despite this, antibiotic resistance in several bacterial species is slowly increasing which calls for continued sustained efforts to preserve effectiveness of available antibiotics. Such efforts will include interventions to further improve antibiotic use and to improve compliance to basic hygiene precautions.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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