1. The Swedish Experience Otto Cars Prof. Infectious Diseases Uppsala University Hospital Sweden

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 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: Antibiotic Resistance Drug Development MorbidityMortalityCosts

8. Hip replacement Transplants Cancer chemotherapy Infections in preterm babies

9. Overall objective To preserve effective antibacterial therapy for the future The Swedish Experience The Swedish Strategic Programme Against Antibiotic Resistance http:// www.strama.se

10. NATIONAL LEVEL National co-ordinating group Surveillance National projects LOCAL LEVEL Local co-ordinating groups Implementation Behavioural change

11. Intensive care Hospital care Nursing homes Primary care Day care centres School children Projects and interventions initiated in many areas

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. Patient Prescriber Authorities MEDIA Awareness raising of all stakeholders through news media

18. ”Små cipro” avser ciprofloxacin 100 mg 6 resp 10 tabl, 250 mg 10 tabl och 500 mg 10 tabl. Prescriptions of antibiotics for UTI (outpatients) Fluoroquinolones

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. ReAct Action on Antibiotic Resistance www.reactgroup.org