1. 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

2. SWEDEN

3. Sweden
Population – 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

4. STRAMA
Swedish Strategic programme for The Rational use of Antimicrobial Agents and Surveillance of Resistance

5. 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

6. 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

7. 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

8. 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

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

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

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

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

18. Changing patient behaviour
Changing physician behaviour
Patient
Prescriber

19. 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.