Dr Björn Beermann, Sweden

The Swedish Strategic Programme for the Rational Use of

Antimicrobial Agents and Surveillance of Resistance (STRAMA) was initiated in 1994 after signals of increasing resistance to several types of antibiotics were detected. STRAMA is a network of one national multidisciplinary expert group and 30 regional groups.

The goals of the national STRAMA group are:

• to stimulate the formation of regional STRAMA groups;

• to educate health professionals and the public about the problem of inappropriate use of antibiotics and bacterial resistance;

• to design strategies to minimize the development and spread of resistance;

• to further develop and support resistance surveillance programmes.

With the support of the national STRAMA group, each county in Sweden has set up its own regional STRAMA group of multidisciplinary experts. The main objectives of the regional groups are:

• to evaluate the use of antibiotics in the area and the pattern of bacterial resistance;

• to educate health care providers to avoid misuse of antibiotics particularly in hospitals;

• to improve diagnostic procedures in infectious diseases;

• to initiate a study on the treatment of respiratory tract infections and antibiotic use in preschool children.

Since 1993, total antibiotic use has been reduced substantially, especially that of macrolides and broad spectrum antibiotics. The reduction in antibiotic consumption has been more evident in Sweden than in the other Nordic countries. Recommendations on the use of macrolides, vancomycin, and fluoroquinolones, and on the treatment of urinary tract infections, chronic bronchitis, and skin and wound infections, have been produced. A folder containing information on respiratory tract infections, antibiotics and resistance has been distributed to all Swedish health care centres. Symposia have been arranged for regional groups. Media interest for the project has further increased the knowledge and understanding of the problem in the general population. Sweden has been involved in several EU projects on antibiotic resistance.

In conclusion, the overall strategy to fight antibiotic resistance is to build networks with local nodes to collect information and monitor the usage of antimicrobials, and to link the findings to resistance and disease surveillance data. Appropriate policies and education should be provided to ensure the rational use of antimicrobials.