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Improving Antibiotic use through a
Nationwide Decentralized Project –
A Nine-Year Experience
Cars O, Stålsby Lundborg C, Mölstad S
Swedish Strategic Programme for the
Rational use of Antimicrobial Agents and
Surveillance of Resistance (STRAMA), Sweden
SWEDEN
Sweden
• Population – 8.867 million
• Total expenditure on health as % of
GDP – 8.7
• Life expectancy – 80.4 years
• Under five mortality rate per 1000 – 3.5
• Mainly publicly funded healthcare
• Drug sales are exclusively through the
• National corfporation of Swedish
pharmacies
STRAMA
Swedish Strategic programme
for The Rational use of
Antimicrobial Agents and
Surveillance of Resistance
http:// www.strama.se
STRAMA- Primary objectives
1.Create a cross-sectorial national
forum to
- share information
- formulate national strategies
- support an initiate research activities
- collaborate with media
2. Stimulate the formation of regional
STRAMA - groups in every county
• 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
Examples on STRAMA activities
 Local
treatment guidelines
 Local consumption/resistance patterns
 Feed-back to prescribers
 Patient information leaflets
 Cooperation with media
 Free return visits for patients with respiratory
 tract infections
Examples of local projects
•Parent education in day care centres
•Educational material about infections and
antibiotics for 10 year old school children
•Fictitious patient case notes as educational
tools in infectious diseases,
•Infections and antibiotic treatment in
community nursing homes