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.
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What are antibiotics?
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.
What is antibiotic resistance?
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.
Why is antibiotic resistance a problem?
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.
How does antibiotic resistance spread?
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.
What are the consequences of antibiotic resistance?
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.
How is antibiotic resistance already affecting Sweden?
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.
Are there any new antibiotics being developed?
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.
What is being done around the world to combat antibiotic resistance?
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) of the United Nations have also agreed joint guidelines for the work on combatting resistance. In autumn 2016, antibiotic resistance was for the first time raised as a topic at a high-level meeting of the UN General Assembly. A declaration was adopted in which all UN member countries undertook to support the global action plan at the highest political level. Sweden is leading the international “Joint Programming Initiative on Antimicrobial Resistance (JPIAMR)” in which 19 countries are jointly supporting research into the development of antibiotics, diagnostics and ways to reduce antibiotic resistance. 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.
What action is being taken in Sweden to combat antibiotic resistance?
In spring 2016, the Government adopted a new Swedish strategy on antibiotic resistance to underpin Sweden’s work on curbing the development and spread of antibiotic resistance and to help manage the current situation. There is cross-sector cooperation in Sweden in the fields of healthcare, animal husbandry, and the external environment, for example through a national partnership working to combat antibiotic resistance and healthcare-associated infections. 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:
- preventing healthcare-associated infections and the spread of disease
- promoting the correct use of antibiotics for both people and animals
How are antibiotics used in healthcare?
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:
- during surgery
- in intensive care
- during chemotherapy
What should I think about during the common cold season so that I can help save antibiotics?
Many of us are affected by respiratory infections and colds during the autumn and winter. They are usually caused by viruses, and antibiotics will not help. People who are otherwise in good health will recover from many of these infections by themselves. The 1177 Vårdguiden (Healthcare Guide - tel: 1177) can provide advice on treating respiratory infections. You can also ring 1177 for advice if you are worried about getting an infection.
Antibiotics are only effective against bacterial infections – they cannot cure viral infections such as common colds or flu. And many infections that can be caused by bacteria do not require antibiotics. For example, antibiotics have no, or only a limited, effect on minor or moderate ear infections, sinusitis, tonsillitis or bronchitis. However, antibiotics are crucial in the treatment of pneumonia and can save lives.
If you have a cold, the first thing to do is try to relieve the symptoms. Take painkillers and something to relieve a high temperature as required. If you have a cold and a blocked nose, decongestant nasal sprays may bring relief. You can reduce the risk of being infected or infecting others through good hand hygiene. If you have a cold, ensure that you sneeze or cough in the crook of your arm and use disposable paper tissues.
How does treatment with antibiotics affect the body’s good bacteria?
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 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.
What does it mean to be a carrier of resistant bacteria?
From the moment we’re born, and throughout our lives, we all carry bacteria on the skin, in our airways 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.
When washing your hands, is it enough to use soap and water?
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:
- use soap all over your hands
- rinse off the soap properly
- dry your hands thoroughly after washing them
In my work, I often come into close contact with other people. What responsibility does my employer have for reducing the risk of infection?
Your employer has an ongoing responsibility to assess the infection risks in a workplace and ensure effective hygiene, for example by providing handwashing facilities. If you work in health and social care, for example in pre-schools or elder care, the employer must ensure that the organisation is competent to assess the risks of infection. If the organisation does not have the necessary skills, they must be externally sourced, for example through occupational health services. You can find out more about how to mitigate the risk of infection in the work environment on the Swedish Work Environment Authority’s website.
Can I purchase antibiotics on the Internet?
The Swedish Medical Products Agency advises against purchasing antibiotics on the Internet without first seeing a doctor 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:
How are antibiotics used on animals in Sweden?
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 2015, approximately 60 tonnes of antibiotics were used on people in Sweden while only about 10 tonnes were used on our animals. Sales of antibiotics for animals has been gradually declining since the early 1990s.
A vet will judge whether or not an animal needs antibiotics
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:
- cases of infectious diarrhoea and pneumonia in young animals
- udder inflammation in adult dairy cows
What can I do as a dog or cat owner to help combat antibiotic resistance?
- Healthy animals do not need antibiotics. Learn more about how to care for your animals so as to prevent disease. A good living environment, excellent care and suitable food all help to ensure good health.
- Contact a vet for advice if your pet is unwell.
- Follow the advice of your vet as to when antibiotics may be helpful.
- Take leftover antibiotics to the pharmacy rather than using them or throwing them away.
- Avoid infecting others and becoming infected yourself – maintain good hand hygiene when in contact with an animal’s food or if your animal has a wound.
What can I do as the owner of horses or of food-producing animals to help combat antibiotic resistance?
- Healthy animals do not need antibiotics. A good environment, excellent care and suitable food all help to ensure good health.
- Maintain good hygiene – wash your hands with soap and water, use clean shoes, boots, clothes and equipment in the stable and ensure that any vehicle used for transportation is clean.
- Keep ill or infected animals separate from healthy animals to counter the spread of infection.
- If you are planning to buy animals, check whether there are any problems with disease in the seller’s livestock and think about what to do to prevent your own stock being infected, perhaps by keeping newly-purchased animals in isolation for a while.
- Follow the advice of your vet as to when antibiotics are needed or not needed.
- Take leftover antibiotics to the pharmacy rather than using them or throwing them away.
- Find out more about infection control for farm animals at smittsäkra.se
- Are you a horse owner? – See the National Veterinary Institute (SVA) checklist
Food and the environment
Can antibiotic-resistant bacteria spread through food?
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.
Follow the National Food Agency’s advice on good hygiene in the kitchen
A recent study shows that the risk of people in Sweden being infected with resistant bacteria through their food is low. 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.
What advice should I follow to avoid taking in bacteria through food?
To avoid taking in bacteria, follow the National Food Agency’s general advice on hygiene in the kitchen. The most important advice is:
- Wash your hands before you start cooking, but also immediately after handling raw meat, including chicken.
- Use clean equipment, keep the worktop clean, and wash knives and chopping boards carefully after cutting up raw meat, including chicken.
- Ensure poultry and minced meat are well cooked; do not eat raw mince.
- Wash all vegetables.
Does meat sold in Sweden contain antibiotic residues?
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.
How does the release of antibiotics into the environment contribute to antibiotic resistance?
Antibiotics can get into the environment in different ways. For example:
- during the manufacturing process
- through traces of medicines in urine and faeces following antibiotic treatment
How can we reduce the release of antibiotics into the environment?
To reduce the release of antibiotics into the environment, we should ensure that:
- there is no release of antibiotics during the manufacturing process that could lead to bacteria developing resistance
- we improve the treatment of waste water, reducing the inflow of antibiotics into the environment
- we only use antibiotics when they are beneficial
- we take leftover antibiotics to the pharmacy
Some products are labelled ‘antibacterial’. What does this mean?
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.
Are antibacterial products necessary?
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.