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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
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SWEDEN
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• 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

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STRAMA Swedish Strategic programme for The
Rational use of Antimicrobial Agents and
Surveillance of Resistance http//
www.strama.se
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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
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• 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

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• 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

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• 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