Exploring Sweden’s Approach to Antibiotic Resistance in the Human Health Sector

Key priorities for containing antibiotic resistance in human health in Sweden involve preventing infections in healthcare settings and in society in general, regulating sales of antibiotics, up-to-date treatment recommendations and good availability of data on antibiotic use and resistance. Importantly, surveillance data is of high quality, transparent and communicated widely.

Three people in front of a hospital. Illustration.

Providing a conducive environment for innovation, research and development for new vaccines, diagnostics, and medications is also an important ingredient in the response.

The Strama model for collaborations at all levels

Strama, founded in 1995, is the mechanism and work method for antibiotic stewardship in Sweden. Strama operate on both national and regional level and permeates all work in human medicine relating to antibiotic prescribing and use.

Strama was originally formed as a voluntary network of regional groups, national authorities and organisations to promote collaborations and share best practices. Regional Strama groups typically have representatives from various fields of healthcare such as infectious disease, primary care, pharmacy, communicable disease control, microbiology and infection control. Strama is also active within dentistry.

Data on antibiotic consumption and use is widely communicated by the Public Health Agency and the regional Strama groups, to benchmark regions and healthcare centres. Strama groups also use the data to lead peer-to-peer discussions about prescribing policies and adherence to treatment guidelines, as well as inform local stewardship interventions.

Infection prevention and control is another corner stone in the containment of antibiotic resistance. Regional Strama groups and regional infection prevention and control groups collaborate closely, and there is integration between the arenas of antibiotic stewardship, infection prevention and control, and the prevention of healthcare-associated infections at the national level.

Learn about Strama in this E-learning course

Learn about Antibiotic rounds as an antimicrobial stewardship tool

Decreased antibiotic consumption and improved quality of prescribing

All antibiotic use in Sweden is by prescription only. In addition to surveillance of antibiotic sales, complementary IT systems allow for diagnostic-linked data on antibiotic use. Indicators of quality of care and prescribing as well as a quantitative national target of no more than 250 prescriptions per 1 000 inhabitants per year in the community sector are important tools for improving antibiotic prescribing through feedback and benchmarking of data on antibiotic consumption and use.

Surveillance on antibiotic sales

IT systems and databases used to monitor antibiotic use in Sweden

  • Primary Care Quality (PVQ) is a tool with automatic collection of existing stored data from electronic medical records with a number of national quality indicators and a module specifically for infections, allowing for diagnosis-linked monitoring. Read more about PVQ
  • Infektionsverktyget (IV) collects data semiautomatically when an antibiotic is prescribed in a hospital and can be used to monitor both healthcare-associated infections and antibiotic use. Read more about Infektionsverktyget (in Swedish)
  • The National Prescribed Drug Register provides a basis for official statistics on all prescribed drugs dispensed in pharmacies in Sweden, to improve patient safety in the field of pharmaceuticals. Read more about the National Prescribed Drug Register

The community sector (primary care) accounts for the vast majority of antibiotic consumption in Sweden. Convenient treatment recommendations, in a brochure, a website and a free mobile app, are available to help prescribers.

National treatment recommendations for common infections in community care

Availability of antibiotics

High quality prescribing requires access to both new and old antibiotics and access to those of special medical value must be safeguarded. The Government has commissioned the Public Health Agency of Sweden (PHAS) to propose and pilot new models for keeping approved antibiotics available on the Swedish market as well as for increasing availability to new and medically important antibiotics.

The development of new models to ensure access

Resistance monitoring with good geographic coverage

Using standardised methods and established collaboration between national and local laboratories ensures the collection of high quality and comparable resistance data.This data is essential for the development of treatment guidelines and for keeping them up-to-date.

Resistance monitoring

Long tradition of infection prevention and control

Sweden has a long tradition of infection prevention and control (IPC). This is supported by several legally binding regulations, such as standard precautions for all healthcare professionals, requirements of good quality in healthcare, including good IPC practices, and regulations that aim to protect employees from being exposed to infectious diseases. In addition, healthcare providers must have access to expert advice on IPC.

IPC in Swedish health care

Knowledge-management and evidence-based practise

Sweden works with Knowledge-driven management to ensure that healthcare practices arebased on the best available knowledge, originating both from science and tried and tested experience.

Knowledge-driven management (kunskapsstyrningvard.se)

Examples of organisations addressing antibiotic resistance in the human health sector

  • Members of the Intersectoral Coordinating Mechanism
  • Strama - the Swedish strategic programme against antibiotic resistance
  • The Swedish Association of General Practice (SFAM)
  • The Swedish Association of Infection Prevention and Control (SFVH)
  • The Swedish Association of Infectious Disease Doctors (SILF)
  • The Swedish Clinical Microbiology Society (FKM)
  • The Swedish Pharmaceutical Society
  • Swedish Reference Group for Antibiotics (SRGA)

Learn More

Health Care in Sweden

In Sweden, health care is accessible to all citizens under The Health and Medical Service Act, funded primarily through general taxation. Responsibility is shared among the central government, regions, and municipalities. There are both public and private healthcare providers.

The Central Government establishes principles and guidelines, instigates laws and agreements and sets the political agenda for health and medical care.

The 21 regions provide healthcare services and are responsible for overall planning and resource allocation and consolidate specialised care with the region, as well ascollaborations across regions. There are approximately 70 hospitals and seven university hospitals in Sweden.

Primary care is offered through approximately 1,200 healthcare centres, and most operate as multi-professional team-based practices.

Municipalities are responsible for care of the elderly in the home or in long-term care facilities for people with disabilities, and providing support and services for people released from hospital, as well as for healthcare within schools.

The health and medical costs in Sweden are paid for by regional and municipal taxes and contributions from the national government as well as through patient fees.