Internationally, Norway receives positive attention mainly in the context of Winter Olympics or peace initiatives. However, an Associated Press article recently suggested that the Norwegian health care system had «found the Solution to Killer Superbug». Furthermore, Norway was proclaimed «The Most Infection Free Country in the World». What my be the reality behind such headlines, and how shall we as a nation maintain a favourable situation?
Physicians in Scandinavian countries and the Netherlands have a long tradition for modest prescription of antibiotics, and are trained to use agents with a narrow antimicrobial spectre whenever possible. This is probably the main reason why these countries have had less antibiotic resistance than others.
The number of antibiotics marketed in a country correlates positively with total drug consumption. Until 1992, Norwegian authorities could reject marketing of new compounds if national experts found no medical need for them. The foresight of senior colleagues has led to the number of marketed antibiotics in Norway, even today, being 10-fold lower than in some other European countries.
The national surveillance programme, NORM, reports antimicrobial resistance in human pathogens on an annual basis. For example, national levels of MRSA and ESBL-producing Enterobacteriaceae are still very low whereas ampicillin and ciprofloxacin resistance in E coli and high- level gentamicin resistance in enterococci cause some concern.
Norway has well-established epidemiological surveillance systems in the fields of microbiology and infectious diseases. Nevertheless, more knowledge is needed on how antibiotics are used in hospitals. Two national strategic plans (since 2003) have emphasized the explicit importance of antibiotic surveillance to counteract future antibiotic resistance problems. To fulfil national ambitions, there is an urgent need for economic grants to this field; the human resources are there and as eager to start as Olympic performers!