Summary
Total antibiotic sales in human medicine in Sweden decreased by 2.8% in 2025 compared to 2024.
Antibiotic sales in dental care decreased by 2.6% during the same period.
Antibiotic sales in primary care decreased compared to the previous year, while antibiotic sales on prescription to healthcare facilities increased during the same period.
Since 2020, resistance to cefotaxime in Escherichia coli (ESBL) and the proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolated from blood have been used as indicators of antibiotic resistance in Sweden. Both the proportion of MRSA and the proportion of E. coli resistant to cefotaxime have slowly increased over a ten-year period to the current levels of 2.4% and 9.0%, respectively.
The number of reported cases increased for notifiable bacteria with antibiotic resistance.
For ESBLCARBA, 487 cases were reported, compared to 410 in 2024. Of the reported cases for 2025, seventy-five clusters or pairwise related cases were identified (2–21 cases per cluster). For 29 of the 75 clusters, one or more cases were reported as healthcare-associated infections in Sweden in 2025.
For vancomycin-resistant enterococci, there were seven major (10–80 cases) and twenty-nine minor (2–5 cases) hospital-related outbreaks in 2025.
The number of cases of Neisseria gonorrhoeae has increased over a 10-year period. Resistance to cefixime remains low but has increased to 0.7% since 2024. For the fourth year in a row, ceftriaxone-resistant isolates were identified in Sweden.
Antibiotic sales for use in animals remain stably low and were dominated by narrow-spectrum penicillins.
During 2025, MRSA was isolated from pigs in a study using selective culture methods and sporadically in clinical samples from dogs, horses and cats.
ESBL-producing E. coli are generally rare in both livestock and pets as well as in meat.
Bacteria that produce ESBLCARBA have not been confirmed in domestic animals in Sweden.
Sweden has had a favourable situation compared to many other countries regarding antibiotic resistance in bacteria from humans for a long time, and this remains the case. One reason is that Sweden has effective strategies to promote the responsible use of antibiotics and limit the spread of antibiotic resistance.
Nevertheless, there is an increase in reported cases of notifiable antibiotic-resistant bacteria. This highlights the importance of continuous and consistent work with antibiotic stewardship and infection prevention and control, in healthcare as well as in the community. In healthcare, there are recurring outbreaks of vancomycin-resistant enterococci and an increasing number of healthcare-associated clusters of ESBLCARBA. To prevent healthcare-associated infections, it is crucial that basic hygiene routines are followed and that infection control measures are applied consistently in healthcare settings.
The spread of antibiotic resistance also occurs in the community. In addition to the community spread of MRSA that has been seen over a longer period of time, there are now signs of community spread of ESBLCARBA. This emphasises the importance of working with a whole-of-society approach. For example, Antibiotikasmart Sverige aims to support everyone — individuals, businesses and decision-makers at various levels — to act antibiotic-smart.
Antibiotic sales in human medicine in Sweden dropped sharply during the pandemic but rose in 2022 and 2023. In 2024, sales were largely unchanged compared to the previous year. In 2025, sales decreased compared to the previous year and remain below pre-pandemic levels. Antibiotic sales have generally declined since the peak in 1992, with the largest decrease during this period observed in children aged 0–4 years.
In veterinary medicine, antibiotic sales have decreased sharply since the mid-1980s and have stabilised at a relatively low level in recent years. However, sales of aminoglycosides for group treatment have increased significantly since 2022, which is explained by an increased need for treatment of post-weaning diarrhoea in pigs following the withdrawal in 2022 of preventive veterinary medicinal products with a high content of zinc oxide.
Furthermore, the occurrence of resistance among bacteria from animals has generally been low and stable. For some substances and bacteria, the occurrence has even decreased over time. One such example is ESBL-producing Escherichia coli in broilers. However, there are exceptions; for example, the occurrence of resistance to ampicillin, sulphonamides and trimethoprim has increased in randomly selected E. coli from both broilers and slaughter pigs.
Sales of antibiotics
Antibiotic sales in human medicine
The total amount of antibiotics sold in Sweden decreased by 2.8% in 2025 and now stands at 10.67 DDD per 1 000 inhabitants and day, which is approximately the same as the previous year. This includes all antibiotic sales in human medicine. It includes all antibiotics sold on prescription to individuals and on requisition to various healthcare facilities.
Outpatient care
The number of antibiotic prescriptions dispensed at pharmacies during the year was 256 prescriptions per 1 000 inhabitants, a decrease of 5.7% compared to 2024. Among the country’s 21 regions, 9 regions achieved the national target of a maximum of 250 prescriptions per 1 000 inhabitants. Sales decreased in all age groups, most notably in the group of children aged 5–14 years, where it decreased by 22% compared to the previous year.
Antibiotic sales on prescription in dental care decreased by 2.6% in 2025 compared to the previous year, accounting for 7.0% of all dispensed antibiotic prescriptions during the year. Since 2007, antibiotic sales in dental care have decreased by almost half.
Inpatient care
Total sales of antibiotics on requisition to healthcare facilities increased in 2025 by 2.5% compared to 2024.
Antibiotic sales in veterinary medicine
Sales of antibiotics for animals from pharmacies in Sweden amounted to 9 053 kilograms in 2025. Since 2016, sales of most antibiotic classes have decreased or remained stable. However, compared to previous years, sales of aminoglycosides have increased significantly since 2022, although the increase between 2024 and 2025 was more limited. The increase is explained by rising use of aminoglycosides for the treatment of post-weaning diarrhoea as a result of the withdrawal of veterinary medicinal products with a high content of zinc oxide in 2022. Compared to 2024, sales of aminopenicillins also increased, mainly due to increased sales for poultry, and to a lesser extent for pigs, dogs and cats.
Of the total use in 2025, approximately 57% was narrow-spectrum penicillin. Sales of antibiotics that should be used particularly restrictively (fluoroquinolones, third-generation cephalosporins and polymyxins) were already low in 2016 and have since decreased substantially. Over the same ten-year period, the proportion of products for the treatment of individual animals has been around or above 90% of total sales.
Total sales of antibiotics for animals have decreased by more than two-thirds since 1986, when the use of growth-promoting antibiotics was prohibited. This includes a correction for changes in the number of animals of different species over the years. In the 1990s, the use of antibiotics as medicines for entire animal groups decreased, and in the last two decades, there has also been a decrease in the use of antibiotics for the treatment of individual animals.
Comparison of sales in human and veterinary medicine
In 2025, 61.7 tonnes of antibiotics were sold for the treatment of humans and 9.0 tonnes for the treatment of animals (excluding products for intramammary or intrauterine use). Expressed in relation to body weight (milligrams of active substance per estimated kilogram of biomass), sales were 86.5 milligrams per kilogram for humans and 11.8 milligrams per kilogram for animals.
Notifiable resistance
ESBL-producing Enterobacterales, humans
ESBL-producing Enterobacterales in humans have been notifiable since 2007. It is the most common of the notifiable resistance types.
Results 2025, Enterobacterales with ESBL
Number of reported cases: 13 524 (previous year 12 527), relative change: 8.0% increase.
Number of bloodstream infections: 1 149 (previous year 1 055).
As in previous years, E. coli was the most common species at 83%, followed by Klebsiella pneumoniae at 12%.
The proportion of E. coli from blood cultures that were resistant to third-generation cephalosporins was 9.0%.
Results 2025, Enterobacterales with ESBLCARBA
Number of reported cases: 487 (previous year 410), relative change: 19% increase.
Number of bloodstream infections: 36 (previous year 22).
E. coli was the most common species, at 70%, followed by K. pneumoniae, at 25%.
The number of E. coli from blood cultures that were resistant to meropenem was 8 out of 10 571, compared to 5 out of 10 499 in 2024.
Seventy-five clusters, with between two and twenty-one cases each, have been identified using whole genome sequencing. Among the 75 clusters, there are also 28 clusters that had one or more cases before 2025. For 29 of the clusters, one or more cases were reported as healthcare-associated infections in Sweden in 2025, compared to 27 in 2024.
ESBL-producing Enterobacterales, animals
Bacteria that produce ESBL are not notifiable when found in animals. Such bacteria are generally rare in animals in Sweden. Previously, the occurrence in broilers was high, but it has decreased in recent years. In 2025, the occurrence of ESBL-producing E. coli was investigated in faecal samples from slaughter pigs and broilers, as well as in meat samples from pigs and cattle, using selective methods.
Such bacteria were found in 2% of the faecal samples from slaughter pigs and <1% of the meat samples from pork and beef, but not in any of the samples from faecal samples from broilers.
Bacteria that produce ESBLCARBA have not been confirmed in domestic animals in Sweden.
Staphylococcus aureus resistant to methicillin (MRSA), humans
Community-acquired infection has long been the most common type in humans infected with MRSA in Sweden, accounting for half of the cases. Family/household transmission and community-acquired infection accounted for 25% and 23% of cases, respectively.
Results 2025
Number of reported cases: 4 147 (previous year 3,937), relative change: 5% increase.
Number of bloodstream infections: 131 (previous year 123).
Staphylococcus aureus resistant to methicillin (MRSA), animals
During the year, MRSA was isolated from pigs in a study using selective culture methods and sporadically in clinical samples from dogs, horses and cats. The occurrence in pigs is insufficiently investigated, but in a study with sampling of slaughter pigs at the abattoir and selective culture methods, MRSA was detected in 29% of the tested slaughter groups. How well this reflects the occurrence on farms is not known. In dogs and cats, the number of MRSA cases was 10 and 6, respectively. The types that dominate in these are the same as those found in humans, which suggests that humans are the source of infection. In horses, the number of MRSA cases was 7, which is lower than in 2020–21 (27 and 23 cases, respectively), when there were outbreaks of MRSA in equine hospitals.
Staphylococcus pseudintermedius resistant to methicillin (MRSP), animals
In 2025, the number of reported cases of methicillin-resistant Staphylococcus pseudintermedius (MRSP) in animals was at approximately the same level as in recent years. A total of 45 cases of MRSP were reported to the Swedish Board of Agriculture, of which 43 were from dogs, one from a cat and one from a guinea pig. All isolates except one were available for further investigation. In the first few years after MRSP was found in animals in Sweden, almost all cases were of a certain sequence type (ST71). In recent years, a greater variety of sequence types have emerged (22 different types in 2025), with ST551 being the most common.
MRSP is not notifiable when found in humans.
Streptococcus pneumoniae resistant to penicillin (PRP), humans
Results 2025
Number of reported cases: 211 (previous year 148), relative change: 43% increase.
Number of bloodstream infections: 13 (previous year 12).
Enterococcus faecium and Enterococcus faecalis resistant to vancomycin (VRE), humans
The number of VRE cases varies greatly from year to year, depending on how many and how large the outbreaks have been in hospitals.
Results 2025
Number of reported cases: 516 (previous year 390), relative change: 32% increase.
Number of reported cases of E. faecium with vancomycin resistance: 502 (previous year 372), relative change: 35% increase.
Number of reported cases of E. faecalis with vancomycin resistance: 14 (previous year 18).
Eight cases of VRE were reported with both E. faecium and E. faecalis.
Number of bloodstream infections: 10 (previous year 6).
During the year, there were eight major hospital-related outbreaks with 10–37 cases each. In addition, twenty-nine outbreaks with 2–5 cases each were reported.
Resistance in zoonotic bacteria
Salmonella is rare in animals in Sweden, and isolated strains are usually susceptible to antibiotics. Resistance to fluoroquinolones is rare. Among 108 isolates from animals in 2025, 85% were susceptible to all tested antibiotics. For Salmonella species, resistance among faecal and urine isolates from humans was highest for fluoroquinolones, at 21%. No resistance to carbapenems was reported among Salmonella from animals. Salmonella from invasive infections in humans are more often resistant than isolates from animals in Sweden. This is probably because a large proportion of cases in humans are infected abroad or through imported food.
Campylobacter from animals in Sweden are usually susceptible to relevant antibiotics, and resistance to erythromycin is very rare. In Campylobacter jejuni from humans, resistance to ciprofloxacin was 56% and to tetracycline was 30% in 2025. Resistance to erythromycin was 0.8%.
Infections caused by Salmonella or Campylobacter are generally not treated with antibiotics in either humans or animals. In humans, resistance is therefore only determined for a small proportion of isolates, most of which concern serious infections.
Resistance in clinical isolates from humans
All data for these compilations are collected automatically via Svebar, a collaboration between the clinical microbiology laboratories and the Public Health Agency of Sweden.
E. coli: Resistance in blood isolates to ceftazidime and cefotaxime was 8.1% and 9.0%, respectively. Resistance to ciprofloxacin was 15% and 12% in isolates from blood and urine, respectively, an important consideration when choosing empirical treatment for febrile urinary tract infections.
In the age and gender distribution of results for E. coli from urine, certain differences are seen between the groups. Particularly clear is the high ciprofloxacin resistance (16–20%) in men aged 20 and older.
K. pneumoniae: Resistance in blood isolates to cefotaxime and ceftazidime was 11% for each antibiotic. As with E. coli, resistance to ciprofloxacin is now relatively high, at 15% and 12% in isolates from blood and urine, respectively.
S. aureus: Resistance to cefoxitin (which indicates MRSA) in isolates from blood has decreased to 2.4%, from 2.6% in 2024. For samples from skin and soft tissue, cefoxitin resistance was 2.9%.
E. faecalis and E. faecium: Vancomycin resistance in isolates from blood was 0.1% and 2.2%, respectively. For E. faecium, the increase in high-level aminoglycoside resistance has continued since 2022.
The proportion of S. pneumoniae with penicillin resistance (PRP) from blood cultures was 8.0%.
Clostridioides difficile: The incidence has been relatively stable since 2018 and is now at 60 cases per 100 000 inhabitants and year. Antibiotic resistance was not investigated in 2025.
Resistance in clinical isolates from animals
Bacteria that cause disease in animals are still mostly susceptible to commonly used antibiotics. For example, bacteria that cause respiratory infections in livestock and horses are generally susceptible to benzylpenicillin, but resistance occurs, for example, in Pasteurella multocida from calves. Penicillin resistance is, however, common in Staphylococcus pseudintermedius from dogs and occurs in S. aureus from horses and Staphylococcus felis from cats. Resistance in E. coli from different animal species also occurs and is most common in isolates from faecal samples from young pigs. Resistance testing is justified for the selection of appropriate antibiotics for treatment, especially for E. coli and Brachyspira spp.
Indicator bacteria from healthy animals
Resistance in E. coli in the intestinal flora of healthy animals can be used as an indicator of the spread of antibiotic resistance in the bacterial flora of an animal population and indirectly as an indicator of the extent of antibiotic use in animals. In Sweden, the occurrence of resistance in these indicator bacteria is low in most of the animal species investigated, and the situation is favourable from an international perspective. For example, 79% and 68% of E. coli from healthy broilers and slaughter pigs in the most recent surveys were susceptible to all tested substances.