The Swedish Experience

1
The Swedish Experience

• Otto Cars
• Prof. Infectious Diseases
• Uppsala University Hospital
• Sweden

2
(No Transcript)
3
The Global Challenge Antibiotics are losing
their effect at a pace that was unforeseen just
five years ago The pipeline of new drugs is
empty
4
ESBL (CTX-M) producing Enterobacteriaceae
5
The consequences.

• Bloodstream infection 43.5 of the children with
  Gram-negative bloodstream infection died in a
  Tanzanian study (Blomberg, 2007).
• ESBL MDR Gram-negatives In Israel 3 of all
  fatalities in hospitals related to Gram-negative
  multiresistant nosocomial infections (Carmeli,
  2006).

www.reactgroup.org
6
Clonal outbreak of av multiresistant Klebsiella
pneumoniae Uppsala University Hospital
7
The Current Paradox
AntibioticResistance
DrugDevelopment
Morbidity Mortality Costs
8
Hip replacement
Transplants
Cancer chemotherapy
Infections in preterm babies
9
The Swedish Experience

• The Swedish Strategic Programme
• Against Antibiotic Resistance

Overall objective To preserve effective
antibacterial therapy for the future
http// www.strama.se
10
NATIONAL LEVEL National co-ordinating
group Surveillance National projects
LOCAL LEVEL Local
co-ordinating groups Implementation
Behavioural change
11
Projects and interventions initiated in many
areas
Primary care
Intensive care
Day care centres
Hospital care
School children
Nursing homes
12
NATIONAL LEVEL National co-ordinating
group Surveillance National projects
LOCAL LEVEL Local
co-ordinating groups Implementation
Behavioural change
13

• 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

14

• Strama-some examples of activities
• Local implementation of guidelines
• Sales statistics, Resistance data
• Feedback and audit
• Newsletter, website,
• Fund for local projects
• Educational activities Strama workshops

15
Effect of prescriber feedback on consumption of
fluoroquinolones in four primary care districts
of Uppsala County
DDD/1000ính/day
16

Effect of prescriber feedback on consumption of
fluoroquinolones in four primary care districts
of Uppsala County
DDD/1000ính/day
17
Awareness raising of all stakeholders through
news media
Patient
Prescriber
Authorities
MEDIA
18
Prescriptions of antibiotics for UTI (outpatients)
Fluoroquinolones
Små cipro avser ciprofloxacin 100 mg 6 resp 10
tabl, 250 mg 10 tabl och 500 mg 10 tabl.
19
(No Transcript)
20
Total sales of Antibiotics in the Nordic
Countries 1978-2006
DDD/1000 inhabitants/day
Excluding Metenamine. Before 1998 figures from
Denmark do not include hospital use.
21
Possible success factors Multidisciplinary
coordinating group- involving all stakeholders
Governmental support and mandate Decentralised
organisation and local ownership Credible,
scientifically based messages and actions Clear
communication and media strategy
22
Conclusions It is possible to achieve a
significant change in antibiotic use at the
national level. To be sustainable,
political/financial support is needed. Despite
low antibiotic consumption resistance rates are
incrasing
23
ReActAction on Antibiotic Resistance 
www.reactgroup.org