This section features common questions about antibiotic resistance and some answers. All factual information is provided by experts from the agencies and organisations that are working together to combat antibiotic resistance and healthcare-associated infections, and represents the latest knowledge in a range of different fields.
Antibiotics are medicines that are used to treat bacterial infections in people and animals. Bacterial infections can develop in different ways. Minor infections will heal without antibiotic treatment, while others may lead to complications or even prove fatal. Antibiotics work by disrupting essential bacterial functions or by killing the bacteria. We commonly refer to antibiotics as “penicillin”, but that is only one of several types of antibiotic. Many common infections, such as colds, are caused by viruses, and antibiotics do not work on virus infections.
Antibiotics are a group of medicines used to treat bacterial infections. Bacteria can develop resistance to the medicines. Resistance is bacteria’s natural method of adapting in order to survive. The more antibiotics we use, the faster resistance will grow.
Infections caused by resistant bacteria are more difficult to treat. Antibiotic resistance is now a growing public health problem. In some countries there are now bacteria that are resistant to almost all antibiotics. Up to now, Sweden has escaped relatively lightly compared to many other countries in the world, but antibiotic resistance is a growing concern here too.
Antibiotic-resistant bacteria spread like other bacteria – they can be transmitted between people, animals, food and throughout our environment. They spread across the world due to travel and trade. Antibiotic resistance also spreads through bacteria exchanging resistance with each other. Resistance can thus be transmitted between different strains of bacteria and also between different bacterial species. The more antibiotics we use, the faster resistance will grow.
If disease-causing bacteria become resistant to antibiotics, it is more likely that an infection will take longer to treat or that treatment will be unsuccessful. In the worst cases, the patient may die from the infection. Advanced modern healthcare relies on antibiotics working against infections, for example during surgery or chemotherapy or in intensive care. Antibiotics are also needed in veterinary medicine to cure sick animals. Increased complications in cases of infection also entail greater costs for society.
Sweden uses fewer antibiotics on both animals and people than many other countries and has less trouble with resistant bacteria. But resistant bacteria can cause problems here too. For example, some patients with urinary tract infections have to take antibiotics intravenously when antibiotics in tablet form do not work, and then need to be treated in hospital. Another example is where resistant bacteria have spread in wards treating premature babies, with some children dying as a result. In addition to the considerable suffering of those affected and their families there are increased costs to society.
The development of antibiotics by the pharmaceutical industry has slowed down in the last 30 years. Although some new preparations are on the way, it will be some time before we will be able to use them, and more research and development are needed. There is a particular shortage of new antibiotics able to counter infections caused by resistant gut bacteria.
Antibiotic resistance is a global problem, and so various countries and international players are working together to find sustainable solutions. An example of such initiatives is the global action plan adopted by the World Health Organisation (WHO) in 2015 to guide the work of member states on antibiotic resistance. The plan states that every country has committed to taking action in their own country within all sectors of society. The member countries of the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization (FAO) as well as the United Nations environment programme (UNEP) have also agreed joint guidelines for the work on combatting resistance. The EU also has the work against antibiotic resistance high on its agenda, with many different activities to support member states as well as for coordination with the aim to influence countries outside the EU. Sweden is and has been a leading country and contributes to strengthening others. At the Public Health Agency there is a WHO collaborating centre to support the global work.
Sweden is leading the international “Joint Programming Initiative on Antimicrobial Resistance (JPIAMR)” in which 29 countries are jointly supporting research into the development of antibiotics, diagnostics and ways to reduce antibiotic resistance.
In order to reduce the burden of infection and the use of antibiotics, Sweden’s aid agency Sida works in a number of low and lower middle-income countries around the world to strengthen local health systems and secure access to clean water, sanitation and hygiene.
Sweden is also home to the European office of ReAct, the independent international network dedicated to the problem of antibiotic resistance. They work alongside many players in different countries, and have gathered practical advice and experiences from various countries on ways to combat antibiotic resistance with focus on low and middle-income countries.
Sweden has a national strategy against antibiotic resistance which is the basis of the work to slow down the development and spread of antibiotic resistance and to deal with the current situation. In Sweden, actors in healthcare, animal husbandry, the food sector, research and the external environment collaborate. There is, for example, a national intersectoral coordinating mechanism against antibiotic resistance.
Many organisations are also working on the issue as a part of their day-to-day work. For example, there have been ‘Strama’ groups in county councils and regions working to combat antibiotic resistance since the mid-1990s. For a number of years, work in Sweden on curbing the development of resistance has focused on:
Antibiotics are used in healthcare to treat and in some cases prevent bacterial infections. Using antibiotics enables us to cure diseases that were previously fatal. Advanced modern healthcare relies on antibiotics working against infections, for example:
Every adult carries 1–2 kg of bacteria, and most of these are beneficial. They have many functions, including breaking down various nutrients, but they can also create unfavourable conditions for disease-causing bacteria. Antibiotic treatment affects not only the unwelcome infection but also many of the healthy bacteria in the intestinal tract and in other areas of the body such as our skin, our genital area and our airways. It can take a long time for the bacterial flora to return to normal after antibiotic treatment, which is one of the reasons why we should not use antibiotics unnecessarily.
The normal flora of animals is affected in a corresponding way by antibiotics.
From the moment we’re born, and throughout our lives, we all carry bacteria on the skin, in our airways, our genital area and in our gut. These bacteria are what we call our normal flora and are extremely beneficial. If resistant bacteria get into the normal flora, we do not necessarily become ill but we may help resistant bacteria spread. So we can carry resistant bacteria in our normal flora in, for example, the gut without being ill and without being aware of it. How long we carry these bacteria varies. If the resistant bacteria cause an infection, the infection is more difficult to treat with antibiotics.
Effective hand hygiene is the best and easiest way to prevent the spread of infection. Soap and water are sufficient in most situations. However, it is important to remember to:
If you wash your hands this way, bacteria and viruses on your hands can be rubbed and rinsed away. It is sometimes advisable to have hand sanitiser available too, for example if soap and water are not available or if there is an ongoing spread of infection where you live or work.
The employer has a responsibility to prevent risks of employees becoming infected or becoming permanent carriers of infectious agents, due to their work duties. This applies to all workplaces where there may be risks of infection, regardless of whether you work with animals or with people.
The employer must ensure that you can maintain good hygiene, including washing or disinfecting your hands. If you work in healthcare, for example in preschool or elderly care, there are special hygiene rules that must be followed. You must also receive training on what risks of infection there may be in your workplace and how you can protect yourself from becoming infected. You can read more about ways to prevent infection risks in the work environment on the Swedish Work Environment Authority’s website.
Healthy animals do not need antibiotics, and so in Sweden there is a long-standing tradition of taking preventive action to keep animals healthy. This is one of the reasons Sweden uses the least amount of antibiotics on food-producing animals in the EU; we use significantly fewer antibiotics on animals than on humans. In 2023, approximately 64 tonnes of antibiotics were used on people in Sweden while only about 9 tonnes were used on our animals. Sales of antibiotics for animals has been gradually declining since the mid 1980s.s.
In Sweden antibiotics can only be used on animals if a vet decides that the animal needs treatment. The rules on the use of antibiotics are intended to reduce the risk of resistance and ensure that food from animals does not contain pharmaceutical residues.
Common reasons for using antibiotics on food-producing animals are:
The most common way for bacteria to spread is through direct or indirect contact between infected humans or animals. In terms of food, we can be infected by antibiotic-resistant gastroenteritis bacteria such as campylobacter and salmonella. Often these bacteria do not need antibiotic treatment but they can cause problems. For all bacteria, we can reduce the risk of being infected by following the National Food Agency’s advice on good hygiene in the kitchen. For example, if you ensure chicken or minced meat is well cooked, the bacteria will die whether they are resistant or not.
To avoid taking in bacteria, follow the National Food Agency’s general advice on hygiene in the kitchen. The most important advice is:
The EU has strict rules on the amount of antibiotic residues or residues of other medicines permitted in food. The rules also state that animals treated with antibiotics must not be slaughtered and that you should delay using milk or eggs for a few days following treatment. Doing so ensures that any antibiotic residues in the food are so small that there is no risk to health. Tests show that meat sold in Sweden, whether Swedish or imported, contains only extremely small amounts of antibiotic residues or no residues at all.
Antibiotics can get into the environment in different ways. For example:
When antibiotics get into the environment, there is a greater risk of resistance being developed and spread between harmless environmental bacteria and disease-causing bacteria. There are many harmless bacteria in our external environment that can act as a reservoir for resistance. If these bacteria are exposed to antibiotics, the proportion of resistant bacteria in the environment increases.
To reduce the release of antibiotics into the environment, we should ensure that:
The Swedish Medical Products Agency advises against purchasing antibiotics on the Internet without first seeing a doctor or a veterinarian and getting a prescription. If you think you have a bacterial infection, you should first speak to a doctor, who will then decide what treatment you need. If it turns out that you need antibiotics, your doctor will write a prescription for the antibiotics that are the best treatment for the bacteria that have caused your infection. You can collect your medicine from an approved pharmacy. Approved pharmacies in Sweden display the following symbol:
If you decide to obtain antibiotics or other medicines through an online pharmacy, make sure the pharmacy is displaying the EU-wide symbol that proves that they are selling medicines legally, green for human and blue for animals:
Some products are now promoted as antibacterial. This means that they contain substances that kill bacteria. Shoes, clothes and kitchen equipment are amongst items sometimes labelled this way. EU rules stipulate that all products promoted as antibacterial must be labelled with the name of the substance said to provide an antibacterial effect.
Everyday items such as clothes, chopping boards and toilet seats normally meet hygiene requirements without the use of antibacterial products. Soap and water, washing up liquid or laundry detergent are normally all that are needed to keep them clean. Ask what the antibacterial product contains when you are buying so that you can make a conscious choice.