1 Sales of antibiotics in humans
After the exceptional changes in antibiotic sales during 2020 and 2021 – driven by the COVID-19 pandemic - total sales began to rise again in 2022 and continued to increase through 2023, while remaining lower than before the pandemic. The increase due to the rebound effect seen after the pandemic has slowed down as the sales remained substantially unchanged during 2024 and reduced in 2025 compared to the previous year. Throughout 2025, the epidemiological situation remained within normal parameters, with no significant deviations observed (Public Health Agency of Sweden 2025).
The data sources and methodology underlying the statistics presented in this chapter are described in the Materials and methods, sales of antibiotics section. Due to regulations regarding the confidentiality of sales data, detailed data for substances and substance groups cannot be shown measured in DDD per 1 000 inhabitants. This affects the section for total sales as well as inpatient care.
1.1 Total sales of antibiotics
Results
- Total sales of antibiotics (J01 excl. methenamine) decreased by 2.8% compared to 2024 (from 10.97 DDD to 10.67 DDD per 1 000 inhabitants per day), Figure 1.1.
- Total sales of antibiotics varied between regions, ranging from 8.94 DDD per 1 000 inhabitants per day in Jönköping region to 11.78 DDD per 1 000 inhabitants per day in Blekinge region, Figure 1.1.
- Beta-lactamase sensitive penicillins (J01CE) and tetracyclines (J01AA) remain the two most sold antibiotic classes measured in DDD per 1 000 inhabitants in Sweden during 2025 (data not shown). The sales in outpatient care and inpatient care constitute 85% and 15% of the total sales, respectively.
1.2 Antibiotics in outpatient care
1.2.1 Total sales in outpatient care
Results
In 2025, 256 prescriptions per 1 000 inhabitants were sold in Sweden – a decrease of 5.7% compared to 2024.
Sales of antibiotics decreased in all age groups and most in the the younger age groups (0-4 and 5-14) in 2025, with the largest decrease observed for children aged 5-14 years (22% decrease compared to 2024, Figure 1.2). Compared to 2019, all age groups showed a decrease in sales and most in the age group 0-4, showing a decrease of 21%.
A decrease in sales was observed for many of the antibiotic classes in 2025, however an increase was observed for amoxicillin (J01CA04), pivmecillinam (J01CA08), trimethoprim (J01EA) and trimethoprim with sulphonamides (J01EE), Figure 1.3.
Beta-lactamase sensitive penicillins (J01CE) and pivmecillinam (J01CA08) were the most commonly sold antibiotics in 2025 measured in number of prescriptions.
The number of prescriptions per 1 000 inhabitants varied between 216 in Västerbotten region to 294 in Blekinge region in 2025. Antibiotic sales decreased in all regions during 2025, Figure 1.4.
In 2025, 15% of the Swedish population was treated with at least one course of antibiotics, ranging from 12% in Västerbotten region to 17% in Blekinge region, Figure 1.5.
Comments
The sales of antibiotics have decreased by 54% since 1992, when the prescription of antibiotics peaked. The greatest decrease during this period was observed in children aged 0-4 years, dropping from 1 328 prescriptions per 1 000 inhabitants in 1992 to 238 in 2025, a decrease of 82%. In 2020 the national long-term target of 250 prescriptions per 1 000 inhabitants per year was achieved nationally for the first time (Strama 2025). Nine of 21 regions reached this annual target in 2025. The sales of fluoroquinolones (J01MA) decreased in 2023 and continued to decrease in 2024 and 2025, compared to both 2024 and 2019, which is in line with recommendations for restrictive use due to known risks of side effects (European Medicines Agency (EMA) 2019). The increase observed in a number of antibiotic groups was greatest for for amoxicillin (J01CA04) and can be attributed to the availability of the product in the swedish market after a period of shortage.
1.2.2 Antibiotics commonly used to treat certain infections in outpatient care
Results
Overall sales of antibiotics commonly prescribed against RTIs decreased by 9.1% in 2025 compared to 2024.
At a national level, the number of prescriptions per 1 000 inhabitants for RTIs varied between 134 in Blekinge region to 81 in Västerbotten region in 2025, Figure 1.6.
Comments
The sales for antibiotics commonly used to treat RTIs increased during 2023 and 2024. The sales decreased in 2025 and continue to remain under pre-pandemic levels. For all regions, the majority of antibiotic prescriptions during 2025 were for antibiotics commonly used to treat RTIs. Consistent with long-term observations of antibiotic sales, antibiotics commonly used to treat RTIs show larger regional variations than the remaining groups.
1.2.3 Respiratory tract infections (RTIs)
Results
Beta-lactamase sensitive penicillins (J01CE02) were the most sold of antibiotics commonly prescribed for RTIs in outpatient care in 2025, however a decrease of 12% was observed compared to 2024, Figure 1.7.
Sales of antibiotics commonly prescribed for RTIs in outpatient care decreased for most of the antibiotics and most for doxycycline (J01AA02), with a 12% decrease. An increase of 12% compared to 2024 was observed for amoxicillin (J01CA04). Sales of cephalosporins (J01DB-DE, ceftibuten excluded), for macrolides (J01FA) and for amoxicillin with clavulanic acid (J01CR02) decreased by 9.7%, 9.4% and 1.5% respectively compared to 2024, Figure 1.7.
Comments
The recommended first-line treatment for lower RTIs in Sweden is penicillin V (J01CE02) (Public Health Agency of Sweden et al. 2014). In 2025, the total sales of antibiotics commonly used to treat RTIs were lower than in 2024, and remain lower than pre-pandemic levels. Trend analysis based on data during the period 2000-2025 showed a significant decrease in the sales of penicillin, cephalosporines, macrolides and doxycycline. Amoxicillin with an enzyme inhibitor (J01CR02) showed an increase since 2017. For amoxicillin, however, there is a significant increase at the beginning of the period (between the years 2000 and 2001) followed by a decrease during the period 2002–2025.
1.2.4 Urinary tract infections (UTIs)
Results
Sales of antibiotics commonly used to treat UTIs decreased by 2.4% in 2025 among women aged 15-79 compared to 2024. Sales of pivmecillinam (J01CA08) and trimethoprim (J01EA) increased by 5.3% and 1.5% respectively, whereas nitrofurantoin (J01XE) and ciprofloxacin (J01MA02) decreased by 11% and 5.8%, Figure 1.8.
In men aged 65 or older, the sales of antibiotics commonly used to treat UTIs increased marginally by 0.2% in 2025 compared to 2024. The greatest relative change was observed for pivmecillinam (J01CA08) and trimethoprim (J01EA) increased by 6.8% and 5.7% respectively, Figure 1.9.
At the national level, just over 10% of the antibiotics commonly prescribed for UTIs in women aged 18-79 in 2025 consisted of ciprofloxacin. This proportion ranged from 7.0% in Jönköping region to 13% in Västernorrland region, Figure 1.10.
Comments
According to national treatment recommendations, pivmecillinam and nitrofurantoin are first-line treatments for UTIs in women aged 15 or older and in men with afebrile symptomatic UTIs (Public Health Agency of Sweden et al. 2014). In line with treatment recommendations, 87% of the antibiotics commonly prescribed for UTIs that were sold to women aged 15-79 in 2025 consisted of these two antibiotics. The increase in sales of pivmecillinam (J01CA08) can be attributed to a recommendation from Strama to use it instead of nitrofurantoin (J01XE) when appropriate, due to a risk of shortage for pivmecillinam (Strama 2026). This guidance has been withdrawn, as nitrofurantoin is no longer considered to be at risk for shortages. In men aged 65 or older, fluoroquinolones made up 33% of the UTI antibiotics sold in 2025. In this group, the trend analysis shows a significant increase in the sales of nitrofurantoin and trimethoprim with sulphonamides during the period 2000-2025. Sales of fluoroquinolones and trimethoprim show a significant decrease since the beginning of the 2000s. Sales of pivmecillinam increased in this population since 2005, according to trend analysis. Note that since 2021, norfloxacin (J01MA06) has been removed from the market and only ciprofloxacin (J01MA02) remains among the fluoroquinolones.
According to Strama’s quality indicator for outpatient care, a maximum of 10% of antibiotics prescribed to treat UTIs in women aged 18-79 years should consist of fluoroquinolones (Strama 2025). This target was achieved by nine of 21 regions in 2025.
1.2.5 Age and gender comparisons
Results
The rate of antibiotic prescriptions in outpatient care followed the same pattern as in 2024, i.e. the highest prescription rates were observed for people aged 85 years or older; 686 prescriptions per 1 000 inhabitants in women and 650 prescriptions per 1 000 inhabitants in men in 2025, Figure 1.11. 61% of all antibiotic prescriptions during 2025 were issued to women. Antibiotics commonly used to treat UTIs are mostly prescribed to women, and the prescription rate increases with age (data not shown).
Comments
In general, comparisons across age groups show that antibiotics are used more in the older age groups. As mentioned in Guidance for readers, some of the antibiotics used among the elderly population are not included in the outpatient care statistics as some medicines are sold on requisition and included in inpatient care statistics. Therefore, a possible underestimation in the oldest age groups cannot be ruled out.
1.2.6 Antibiotic sales in children
Results
Results
The proportion of children aged 0-6 years treated with at least one course of antibiotics decreased on a national level in 2025 compared to 2024 and was an estimated 14%, Figure 1.12.
At the national level, 73% of antibiotics commonly used to treat RTIs in children aged 0-6 consisted of penicillin V. This proportion ranged from 66% in Kronoberg region to 80% in Västerbotten region, Figure 1.13.
Comments
The proportion of children aged 0-6 years treated with at least one course of antibiotics decreased in all regions during 2025 compared to 2024. According to Strama’s quality indicator for outpatient care, at least 80% of antibiotics prescribed for RTIs in children aged 0-6 years should consist of penicillin V (Strama 2025). To calculate this indicator, the following antibiotics are included in the denominator: amoxicillin (J01CA04), penicillin V (J01CE02), amoxicillin with clavulanic acid (J01CR02), cephalosporins (J01DB-DE excl. ceftibuten J01DD14), doxycycline (J01AA02; excluding packages larger than 50 tablets) and macrolides (J01FA). In 2025, one of the 21 regions achieved this target.
1.2.7 Antibiotics in dentistry
Results
Dentists accounted for 6.1% of all systemic antibiotics (J01 excl. methenamine) prescribed in Sweden in 2025, which is a similar level as the previous year (6.0% in 2024).
Antibiotics (J01 excl. methenamine; metronidazole P01AB01) prescribed by dentists in 2025 was estimated to 17.4 prescriptions per 1 000 inhabitants, a decrease by 2.6% compared to the year before, Figure 1.14.
The most commonly prescribed antibiotic by dentists was penicillin V (83% of total sales in dentistry), Figure 1.14.
Compared to 2024, the sales of penicillin V decreased by 3.5%. The sales of amoxicillin (J01CA04) increased by 19% during 2025 compared to the previous year. Sales of erythromycin (J01FA01) increased by 73% but remain at a low level. Sales of clindamycin (J01FF01), metronidazol (P01AB01) and other antibiotics (in the group J01) decreased by 6.2%, 1.5% and 11%, respectively.
Sales of antibiotics prescribed by dentists decreased in 17 of 21 regions during 2025. There were notable regional differences; dentists in Skåne region issued 22.7 prescriptions per 1 000 inhabitants, more than double that of dentists in Västerbotten region which had 9.2 prescriptions per 1 000 inhabitants, Figure 1.15.
Prescriptions decreased for all age groups except for patients in the age groups 5-19 years and 85+ years of age, where sales increased by 5.8% and 1.8% respectively. Sales decreased the most for patients aged 1-4 years (19.9%). Most antibiotics were prescribed to those aged 65-84 years, followed by those aged 45-64 years, Figure 1.16.
Comments
Antibiotic sales in dentistry continue to decrease since 2022. The sales levels are lower compared to a pre-pandemic level. For patients older than 85 years of age, antibiotic sales in dentistry remain higher than levels observed in 2019. Prescriptions to patients below the age of 1 are not shown, as no antibiotics were prescribed by dentists to patients in this age group during 2025. Penicillin V was the most commonly prescribed antibiotic by dentists, which is in line with recommendations. Metronidazole is also recommended as first-line treatment in combination with penicillin V to attain a broader anaerobic spectrum and is therefore included in the measure of sales. The increase in the sales of amoxicillin could be explained by the availability of the product after a period of shortage in the Swedish market.
1.3 Antibiotics in inpatient care
Data in this section include sales to all Swedish hospitals, some but not all nursing homes, and other institutions within health- and social care that procure antibiotics for dispensing to patients or residents. Of the total sales in inpatient care, the proportion of antibiotics dispensed to acute care hospitals varies from region to region. Some challenges associated with this procurement data are further described in Guidance to readers. Due to regulations regarding confidentiality of sales data, detailed data for specific substances and groups cannot be shown. However, relevant trends over time are described in the text.
1.4 International recommended targets for antibiotic consumption
1.4.1 Swedish antibiotic prescribing according to the WHO AWaRe classification
WHO AWaRe classification
The WHO has set a target for at least 60% of all antibiotics consumed in each country to be from the Access group World Health Organization (WHO) (2025). There are no separate targets for hospital and community consumption based on the AWaRe classification. In 2023, the Council of the European Union (EU) adopted new recommendations aimed at increasing efforts to combat antimicrobial resistance (Council of the European Union 2023). The recommendation set a slightly more ambitious national target: at least 65% of all antibiotics consumed should be from the Access group in the AWaRe classification.
Consumption of Access, Watch, and Reserve antibiotics in Sweden
77% of antibiotics (J01 excluding methenamine J01XX05) sold in 2025 were Access antibiotics, while Watch antibiotics made up 23% of all antibiotics sold and the remaining 0.3% consisted of antibiotics from the Reserve group. As expected, the proportion of Watch antibiotics was higher in inpatient care than in outpatient care, i.e. 32% versus 22% Figure 1.18. Most Reserve antibiotics were sold to inpatient care, but a small proportion was also prescribed in outpatient care and consisted mainly of linezolid, colistin and aztreonam. The sector classified as “inpatient care” also includes antibiotics supplied to other care providers than hospitals, such as some elderly homes and dental care. Thus, it is reasonable to assume that the proportions of Watch and Reserve antibiotics used in hospitals may be higher in reality than the estimates presented here. In addition, since certain antibiotics prescribed and sold on license could not be included (see Chapter 6 - Methods section, sales of antibiotics), it is reasonable to assume that the overall proportions of prescription for these antibiotics may be somewhat underestimated.
Over the last 20 years, the proportion of Access antibiotics has stayed somewhat stable between 77-80%, Figure 1.19. Simultaneously, the proportion of Watch antibiotics increased, while the prescribing of Reserve antibiotics has gradually increased since the early 2000s, as these proportions are smaller in general (Figure 1.20 and Figure 1.21). In 2025, the proportion of Access antibiotics sold was substantially unchanged while the sales of Watch as well as Reserve antibiotics increased.
Sweden exceeds the WHO minimum target for Access antibiotics of 60%, the Council of the EU recommended national target for Access antibiotics of at least 65% as well as the new national target of maintaining a level above 75% according to the new national strategy against antimicrobial resistance in Sweden (Government Offices of Sweden 2026). Note that the Council of the EU uses data from ESAC-Net, which includes methenamine (J01XX05) in AWaRe analysis (European Centre for Disease Prevention and Control (ECDC) 2023). Including methenamine, Sweden continues to exceed the Council of the EU recommended target of at least 65% Access group antibiotics. Although the consumption of Reserve group antibiotics seems to be low, the increased prescribing of these substances merits further review.
1.4.2 Swedish antibiotic consumption based on the EU Council recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach
EU Council recommendations
In 2023, the Council recommendation on stepping up EU action to combat antimicrobial resistance was adopted. One of the recommendation’s targets is to ensure that, by 2030, Access antibiotics make up at least 65% of the total antibiotic consumption in humans, as defined in the AWaRe classification of the WHO. Antibiotic consumption according to the WHO AWaRe classification in Sweden is described in the previous section.
Consumption of antibiotics in Sweden from 2019-2025
Another of the recommendation’s targets is that by 2030, the total consumption of antibiotics in humans (in DDD per 1 000 inhabitants per day) is reduced by 20% in the Union compared with the baseline year 2019. The national target for Sweden is a 3% reduction by 2030. Since 2019, the total consumption of antibiotics in humans in Sweden has decreased by 4%. This report excludes methenamine (J01XX05).
Comments
Nationally, the sales of antibiotics in 2025 remained below the sales volumes observed in 2019, prior to the COVID-19 pandemic. The sale levels in 2025 are lower compared to the previous year. The decrease was also observed regionally as sales volumes in 2025 decreased in 19 of 21 regions compared to 2024. The sales were higher in six of 21 regions compared to sales volumes observed in 2019. A comparison with the population-weighted mean of the EU/EEA countries from 2012-2022 (European Centre for Disease Prevention and Control (ECDC) 2023) and projectory over the following years confirms Sweden’s conservative position regarding antibiotic prescribing. Due to regulations regarding the confidentiality of sales data, detailed data for substance groups cannot be shown.
Total sales of antibiotics (J01 excl. methenamine) in 2021-2025, by region.