How it all startedHow it all started

Increasing incidence of Pc-resistant pneumococci(PRP) in Southern Sweden from ~2% to 8-15% in early 1990s

Deterring international experiences

Who is responsible for action?

Discussion between competent authorities and professional organizations resulted in the formation of a national network for containment of antibiotic resistance (January 1995)

Increasing incidence of PcIncreasing incidence of Pc--resistant resistant pneumococcipneumococci(PRP) in Southern Sweden from ~2% to 8(PRP) in Southern Sweden from ~2% to 8--15% 15% in early 1990sin early 1990s

Deterring international experiencesDeterring international experiences

Who is responsible for action?Who is responsible for action?

Discussion between competent authorities Discussion between competent authorities and professional organizations resulted in the and professional organizations resulted in the formation of a national network for containment formation of a national network for containment of antibiotic resistance (January 1995)of antibiotic resistance (January 1995)

Coordination-nationally-locally

Credibility-the messages need to be scientifically sound

Communication-directed towards different target groups

Collaboration-with other countries, EU and WHO

STRAMA- Primary objectives

1.Create a cross-sectorial national forum to- share information- formulate national strategies- support and initiate research activities- collaborate with media

Guidelines does not work unlessthey are implemented !

Implementation does not workunless there is local comittmentand educational outreach !

STRAMA- Primary objectives

2. Stimulate the formation of regional/localSTRAMA - groups in every county

• STRAMA-groups were formed in every county.

• The County Medical Officers for Communicablehave 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

How did we use the financial Support from the Government?

•Tools for local implementation of guidelines•Sales statistics, Resistance data•National projects, new knowledge•Newsletter, website •Fund for local projects•Educational activities “ STRAMA-days”•Following the international scenario

Intensive care

Hospital care

Nursinghomes

Primarycare

Day care centres

School children

STRAMA projects initiated in many areas

Barriers to implementation

Clinical trials

MMML K

HFP

OR E

DT

S

W

UAB

C

X

Z Y

AC

BD

I

GN

450-600

600-750

750-900

Number of antibiotic prescriptions per 1000 children 0-6 years

900-1050

MMML K

HFP

OR E

DT

S

W

UAB

C

X

Z Y

AC

BD

I

GN

1999 2001MMML K

HFP

OR E

DT

S

W

UAB

C

X

Z Y

AC

BD

I

GN

1997

1050-1200

MMML K

HFP

OR E

DT

S

W

UAB

C

X

Z Y

AC

BD

I

GN

1995

Sales of Antibiotics in the Nordic Countries1978-2004

DD

D/1

000

inha

bita

nts/

day

-

5

10

15

20

25

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Iceland

Finland

Sweden

Norway

Denmark

MRSA in Europe 2004. Data from EARSS.

0 10 20 30 40 50 60 70

Iceland Norway Sweden Holland

Denmark Finland Estonia

Czech rep. Slovenia Austria

Hungary Luxembourg

Slovakia Poland

Germany (267)BulgariaLettland

Latvia Spain

France Belgien Croatia

Israel Italy

Ireland United

Greece Portugal Cyprus

Malta Romania

% MRSA

Patient Prescriber

Authorities MEDIA

Acute otitis media: Outpatient visits and antibiotic treatments at a Swedish primary care centre

0

20

40

60

80

100

120

140

160

1999 2000 2001 2002 2003

No

Outpatient i it

Antibiotictreatments

STRAMA Success factors ?

Culture and traditionInvolving all stakeholdersVoluntaryNo blame-gameBridging the gap between science and politics