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The Swedish Experience

The Swedish Experience. Otto Cars Prof. Infectious Diseases Uppsala University Hospital Sweden. 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. ESBL (CTX-M) producing Enterobacteriaceae.

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The Swedish Experience

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

  2. 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

  3. ESBL (CTX-M) producing Enterobacteriaceae

  4. 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

  5. Clonal outbreak of av multiresistant Klebsiella pneumoniae Uppsala University Hospital

  6. The Current Paradox: AntibioticResistance DrugDevelopment Morbidity Mortality Costs

  7. Hip replacement Transplants Cancer chemotherapy Infections in preterm babies

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

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

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

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

  12. 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

  13. 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”

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

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

  18. 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.

  19. 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

  20. 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

  21. ReActAction on Antibiotic Resistance  www.reactgroup.org

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