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Trimethoprim and sulfonamides (J01EE)0-6 27 25 23 23 20 19 18 177-19 6 6 6 5 4 4 3 320-59 3 3 3 3 3 3 3 360-79 5 4 5 5 9 9 10 1080- 7 8 7 7 18 18 19 18All ages 6 6 5 5 6 6 6 6Macrolides (J01FA)0-6 44 47 41 34 48 52 45 387-19 28 31 25 21 26 28 23 1820-59 28 29 26 23 14 15 13 1260-79 19 19 18 17 13 13 12 1180- 13 12 11 10 12 12 11 9All ages 27 28 25 22 19 20 17 15Lincosamides (J01FF)0-6 4 4 5 5 4 4 6 67-19 6 7 7 8 5 6 6 620-59 11 12 13 14 8 9 9 1060-79 14 16 17 20 14 16 18 2180- 24 25 27 29 22 28 28 32All ages 11 12 13 15 9 10 11 12Fluoroquinolones (J01MA)0-6 1 1 1 1 1 1 1 17-19 11 11 10 9 3 3 3 320-59 48 47 44 40 28 29 29 3060-79 98 93 88 83 98 99 100 10280- 200 185 169 152 231 231 222 212All ages 57 55 51 48 40 41 41 42Nitrofurantoin (J01XE)0-6 11 12 11 11 3 3 3 37-19 8 8 8 8 1 1 1 120-59 9 10 12 13 0 0 0 060-79 9 10 12 14 3 3 4 480- 19 24 29 33 12 12 15 15All ages 10 11 12 14 2 2 2 2All agents (J01 excl methenamine)0-6 724 715 690 643 770 767 733 6907-19 391 414 384 357 300 325 301 27420-59 492 494 469 449 284 288 273 26360-79 599 591 585 593 477 472 471 48080- 979 974 947 922 875 881 851 829All ages 544 546 524 505 378 383 367 354In the last years there has been an increase in the use ofbeta-lactamase resistant penicillins. As seen in Figure 3.4 thisincrease occurred in almost all Swedish counties, expressedas DDD/1000/day. These figures can be interpreted as anincrease in use of dose. Since the number DDDs/prescriptiondid not increase, a change in dose seems unlikely (Figure 3.5).Figure 3.4. Swedish counties, beta-lactamaseresistant penicillins (J01CF), DDD/1000/day, 2000-2003. The counties are sorted after the highest use2003. Data is standardized to minimize differencesin age and sex in the population.DDD/1000/day2,01,81,61,41,21,00,80,60,40,20,0GotlandÖrebroUppsalaKalmarNorrbottenHallandStockholmVästernorrlandJämtlandSödermanlandVästergötlandGävleVästmanlandKronobergSkåneDalarnaJönköpingVärmlandBlekingeÖstergötlandVästerbottenTotal country200320022001200012 S W E D R E S 2 0 0 3
1412J01XE01 - nitrofurantoinJ01EA01 - trimethoprimJ01CA08 - pivmecillinamDDD/prescription1086420ÖrebroJämtlandVästmanlandNorrbottenVästergötlandGotlandUppsalaStockholmHallandSkåneSödermanlandGävleVärmlandBlekingeDalarnaKalmarKronobergJönköpingVästernorrlandVästerbottenÖstergötlandTotal country2003200220012000Proportion in DDD100%80%60%40%20%Figure 3.5. Swedish counties, beta-lactamase resistant penicillins(J01CF), DDD/prescription, 2000-2003. The counties are sorted after thehighest use 2003.One reason for this increase could probably be the ongoingepidemic of impetigo contagiosa caused by S. aureus resistantto fusidic acid. There is an obvious increase in the age groups0-4, 5-9 and 10-14 years, with a peak in August each year,when impetigo can be expected to increase since the childrenstart day care centres and school again after the summer(Figure 3.6).DDD/1000/day6543210jan-00jul-00sep-00nov-00mar-00may-00jan-01mar-01may-01jul-01sep-01nov-01jan-02mar-02may-02jul-02sep-02nov-02jan-03mar-03may-03jul-030 - 45 - 910 - 1415 - 1920 - 5960 - 7980 -sep-03nov-03jan-04Figure 3.6. Beta-lactamase resistant penicillins (J01CF), out-patient care,per month 2000-2003, different age groups.Among antibiotics used for urinary tract infections nitrofurantoinrepresents the greatest difference between 2000and 2003, an increase of 29%, and the relative proportionbetween pivmecillinam, nitrofurantoin and trimethoprimwas slightly affected by this (Figure 3.7 and 3.8). Note thatthe total amount of DDD for these substances against urinarytract infections is about six times larger for women thanfor men.0%Figure 3.7. Proportion of pivmecillinam, nitrofurantoin and trimethoprim,DDD, men in out patient care, 2000-2003 Sweden.Proportion in DDD100%80%60%40%20%0%200020002001200120022003J01XE01 - nitrofurantoinJ01EA01 - trimethoprimJ01CA08 - pivmecillinam20022003Figure 3.8. Proportion of pivmecillinam, nitrofurantoin and trimethoprim,DDD, women in out-patient care, 2000-2003 Sweden.Hospital careThe antibiotic consumption (J01 excl methenamine) in hospitalcare has been constant during the period 2000-2003;1.3 DDD/1000/day. However, slight changes in use are seenfor different groups of antibiotics and penicillins with extendedspectrum accounts for the greatest increase, followed bybeta-lactamase resistant pencillins (Figure 3.9).Beta-lactamase sensitive penicillins (J01CE)Macrolides (J01FA)Tetracyclines (J01AA)Aminoglycosides (J01GB)Imidazole derivatives (J01XD)Cephalosporins (J01DA)Glycopeptides (J01XA)Trimethoprim and sulfonamides (J01EE)Carbapenems (J01DH)Lincosamides (J01FF)Combinations of penicillins (J01CR)Trimethoprim (J01EA)Quinolones (J01MA)Beta-lactamase resistant penicillins (J01CF)Penicillins with extended spectrum (J01CA)-0,010-0,0050,0000,0050,010DDD/1000/day0,0150,020Figure 3.9. Antibiotics (J01) hospital care, changes, DDD/1000/day, 2003compared to 2000.S W E D R E S 2 0 0 3 13
Page 1 and 2: A Report on SwedishAntibiotic Utili
Page 4 and 5: 2.1. SummarySINCE SEVERAL YEARS the
Page 6 and 7: 2.2. SammanfattningAnvändning av a
Page 8 and 9: 3. Use of antimicrobials3.1. Use of
Page 10 and 11: Cephalosporins (J01DA)0-6 0.6 0.5 0
Page 14 and 15: Macrolides (J01FA)Aminoglycosides (
Page 16 and 17: 4. Antimicrobial resistanceIn Swede
Page 18 and 19: Table 4.2. MRSA notified in 2000-20
Page 20 and 21: Notifications of VRE according to t
Page 22 and 23: Table.4.7. E. coli from UTI and blo
Page 24 and 25: Neisseria meningitidisNotifications
Page 26 and 27: mendations from the National Board
Page 28 and 29: ResultsA selection of some of the p
Page 30 and 31: Table App 2.3. Denominator data fro
Page 32 and 33: Appendix 4 - Antibiotic Susceptibil
Page 34 and 35: data in Excel-format for a central
Page 36: STRAMAThe Swedish StrategicProgramm

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