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Public Health Policies on Antibiotic Use and Resistance in Sweden & European Union.: A literature review
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2017 (English)Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
Abstract [en]

Background: Antibiotics are prescribed for treating bacterial infections. However, wrongselection of antibiotics can develop antibiotic resistance and harm instead. Swedish policieson antibiotic use and resistance have been implemented since 1970s and before otherEuropean Union countries. In order to study the effect of public health policies, analyseswere based on articles that provide information on antibiotics use and resistance changesover the past years. This literature review describes the management of Sweden in considerantibiotic prescription, use and resistance and in comparison with European Unioncountries.

Objectives: to analyze wither public health policies affected antibiotic use and resistance inSweden and if it was similar with European Union countries.Methods: PubMed database and inspiration of PRISMA flowchart were used and 11 studieson Sweden and European Union were chosen according to the eligibility criteria.

Results: Sweden had a favorable antibiotic use and resistance after developing morenational plans in early 1990s. There was an increase of antibiotic sales before 1993, andspread of resistances like PNSP. After public policies, antibiotic sales and prescriptionstarted to decrease and reached up to 20% in the out-patient sales in 1997. Moreover,Broad-spectrum penicillin and macrolides use were also decreased in all ages and speciallyin children with Respiratory infection and otitis media which was up to 40% in somecounties between ‘1993-1997’. Guidelines of diagnosing respiratory tract infections andcommon cold were improved and decreased ABS prescription in all Sweden. On the otherhand, there was an increase of sales between ‘2004-2007’ in elderly population and Urinarytract infection patients especially women. Policies didn’t affect 80 years and older patients,antibiotics were in an increase since 1993 and was 12% between‘1995-2008’. While forNursing homes, many policies were implemented for curing urinary and respiratoryinfection, studies showed that there was adherence in early 2000s with slight decrease inuse thus more interventions were needed later. Additionally, comparing with EU, Swedenhad the lowest total antibiotic prescription and exposure with 17.7/ 100 patient whilepenicillin was the most used AB. Additionally, PNSP decreased by 3-5% nationally in 1997in Sweden. In contrast, resistance in nursing homes had increased over years due tononadherence to UTI and RTI recommendations. Comparing to EU, Sweden had thelowest multi –drug resistance and recently had a very low MRSA (less than 1%). On theother hand, many southern EU countries had insufficient policies that resulted in high ABSresistance and use.

Conclusion: Falling numbers of antibiotic prescription, use and resistance were highlyaffected by the national public health policies In Sweden. On the other hand, more policiesand interventions are still needed for nursing homes, elderly and UTI treatments.Continuous evaluation are needed to address the relationship between antibiotic use andresistance from a policy perspective. In general, Sweden -with other Nordic- were frontiersin policymaking thus had favorable antibiotic use and resistance comparing to southernEU countries.

Place, publisher, year, edition, pages
2017. , p. 35
Series
Centre for Public Health Report Series, ISSN 1651-341X ; 2017:16
Keywords [en]
Public health policies, antibiotic use, antibiotic resistance, Sweden, EU.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-141303OAI: oai:DiVA.org:umu-141303DiVA, id: diva2:1153153
Educational program
Master's Programme in Public Health
Presentation
2017-05-23, Natural sciences building N280, Umeå University, Umeå, 15:00 (English)
Supervisors
Examiners
Available from: 2017-12-19 Created: 2017-10-27 Last updated: 2017-12-19Bibliographically approved

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CiteExportLink to record
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Citation style
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