Major change in the use of antibiotics following a national programme: Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance (STRAMA).

In order to reduce inappropriate use of antibiotics and to counteract the increase in antimicrobial resistance in community-acquired and nosocomial infections, a national project was initiated in Sweden in 1994: the Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance. In the first years the project focused on inappropriate prescribing of antibiotics to children with respiratory tract infections and on the surveillance of resistance in pneumococci. Statistics on antibiotic sales on a national and county level and for different age-groups were studied. Between 1993 and 1997 antibiotic prescribing was reduced by 22%, from 16.3 to 13.0 defined daily doses (DDD) per 1000 inhabitants/d. The reduction was most pronounced for children, 0-6-y-old, from 15.7 to 9.7 DDD/1000 children/d. Macrolides and amoxicillin/co-amoxyclav decreased most. There were large variations in antibiotic sales in different counties, and a decrease was also noted in counties starting from a low level. In the county with the highest sales in 1993, antibiotic prescribing to children was reduced by 40%. The national frequency of penicillin-non-susceptible pneumococci (MIC > or =0.1 mg/l) has not increased during the 1990s and the increasing incidence in southern Sweden seems to have been curtailed. During the period that the project has been running, a major change in the use of antibiotics, especially for pre-school children, has been achieved.