Reduction of antibiotics sales and sustained low incidence of bacterial resistance : report on a broad approach during 10 years to implement evidence-based indications for antibiotic prescribing in Jönköping County, Sweden

• Background: Increased prevalence of resistance in major pathogens decreases the possibility to treat common infectious conditions. In the beginning of the 1990s, resistant pneumococci spread among children in southern Sweden, which alarmed both the profession and the medical authorities. We describe the measures taken to curb the spread of resistance and to reduce the use of antibiotics in outpatient care.Method: A national organization, Strama (Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance), was initiated in 1994 and a regional committee was formed in Jönköping County in 1995. A multifaceted program was started aiming at reducing antibiotic use in the county by 25% and that the prevalence of resistant pneumococci should not increase.Results: The efforts by the Jönköping County committee has resulted in a 31% total reduction of the consumption of antibiotic drugs in primary care between 1993 and 2005 and a 50% reduction among children aged 0 to 4 years. There has been no increase in the prevalence of resistant pneumococci or Haemophilus influenzae in the county. The decrease in antibiotic use was greater than the average in Sweden.Conclusion: Our regional efforts have been successful. This has probably been achieved by a sustained strategy including repeated campaigns in the media, information to the profession, implementation of guidelines, and feedback to the profession on data on antibiotic prescribing and resistance. We believe it is of outmost importance not only to inform the profession but also the public on the limited effects of antibiotics in most respiratory tract infections.

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