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Lessons learnt during 20 years of the swedish strategic programme against antibiotic resistance

Magazine article
Authors S. Mölstad
S. Löfmark
K. Carlin
M. Erntell
O. Aspevall
L. Blad
H. Hanberger
K. Hedin
J. Hellman
C. Norman
G. Skoog
C. Stålsby-Lundborg
K. Tegmark Wisell
Christina Åhrén
O. Cars
Published in Bulletin of the World Health Organization
Volume 95
Issue 11
Pages 764-773
ISSN 0042-9686
Publication year 2017
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 764-773
Language en
Keywords antibiotic agent, cephalosporin, penicillin derivative, antibiotic resistance, antibiotics, bacterium, bottom-up approach, decision making, health monitoring, health services, public health, strategic approach, access to information, Article, clinical decision making, health program, health survey, hospital bed utilization, human, hygiene, infection control, mass communication, pharmacy, practice guideline, prescription, primary health care, socioeconomics, Sweden, Bacteria (microorganisms), Streptococcus pneumoniae
Subject categories Infectious Medicine


Increasing use of antibiotics and rising levels of bacterial resistance to antibiotics are a challenge to global health and development. Successful initiatives for containing the problem need to be communicated and disseminated. In Sweden, a rapid spread of resistant pneumococci in the southern part of the country triggered the formation of the Swedish strategic programme against antibiotic resistance, also known as Strama, in 1995. The creation of the programme was an important starting point for long-term coordinated efforts to tackle antibiotic resistance in the country. This paper describes the main strategies of the programme: committed work at the local and national levels; monitoring of antibiotic use for informed decision-making; a national target for antibiotic prescriptions; surveillance of antibiotic resistance for local, national and global action; tracking resistance trends; infection control to limit spread of resistance; and communication to raise awareness for action and behavioural change. A key element for achieving long-term changes has been the bottom-up approach, including working closely with prescribers at the local level. The work described here and the lessons learnt could inform countries implementing their own national action plans against antibiotic resistance.

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