Improving Antibiotic use through a Nationwide Decentralized Project –

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Improving Antibiotic use through a Nationwide Decentralized Project – A Nine-Year Experience Cars O, Stålsby Lundborg C, Mölstad S Swedish Strategic Programme for the Rational use of Antimicrobial Agents and Surveillance of Resistance (STRAMA), Sweden

SWEDEN

Sweden Population – 8.867 million Total expenditure on health as % of GDP – 8.7 Life expectancy – 80.4 years Under five mortality rate per 1000 – 3.5 Mainly publicly funded healthcare Drug sales are exclusively through the National corfporation of Swedish pharmacies

STRAMA Swedish Strategic programme for The Rational use of Antimicrobial Agents and Surveillance of Resistance http:// www.strama.se

STRAMA- Primary objectives 1.Create a cross-sectorial national forum to - share information - formulate national strategies - support an initiate research activities - collaborate with media 2. Stimulate the formation of regional STRAMA - groups in every county

STRAMA-groups were formed in every county. The County Medical Officers for Communicable have a leading role in these groups which include specialists from different medical fields The main objective is to evaluate the use antibiotics and antibacterial resistance in the region and to improve prescribing patterns

Examples on STRAMA activities Local treatment guidelines Local consumption/resistance patterns Feed-back to prescribers Patient information leaflets Cooperation with media Free return visits for patients with respiratory tract infections

Examples of local projects Parent education in day care centres Educational material about infections and antibiotics for 10 year old school children Fictitious patient case notes as educational tools in infectious diseases, Infections and antibiotic treatment in community nursing homes

Antibiotics (ATC group J01), age group 0-6 years, municipalities in Sweden with the highest and lowest consumption, 1998 and 2002.

Effect of prescriber feedback on consumption of fluoroquinolones in four primary care districts of Uppsala County DDD/1000ính/day

Effect of prescriber feedback on consumption of fluoroquinolones in four primary care districts of Uppsala County DDD/1000ính/day

Acute otitis media in children 2-15 years 2000 n=311 7% no antibiotics 2002 n=222 11 % no antibiotics

Changing patient behaviour Changing physician behaviour Patient Prescriber

This nationwide system ( supported by the government since year 2000) has shown to be sustainable. There were significant decreases in total antibiotic use in targeted groups and antibiotic classes. The total antibiotic use in children continues to decrease Marginal or no increase in national resistance rates has been seen, in contrast to the situation in many other countries.