Import of antibiotics by air travellers - an observational study at airports in Sweden and Norway.

BACKGROUND: Overuse and misuse of antibiotics are two of the main drivers of antimicrobial resistance (AMR). In some countries antibiotics can be purchased over the counter, whereas in Scandinavia and most of Europe, antibiotics require a prescription. It is permitted to bring medicines for personal use to Scandinavia. This raises concerns about whether antibiotics are being imported into low-prescribing countries, such as Scandinavia, via international airports. We aimed to investigate the quantity and types of antibiotics imported by air travellers entering Norway and Sweden, based on routine customs inspections at international airports. METHODS: A cross-sectional observational study was conducted during daytime over five weekdays at three international airports in Sweden and Norway. Anonymous data including the presence, type, and quantity of antibiotics, were registered alongside routine customs inspections. Defined daily doses (DDDs) were calculated for oral antibiotics. Substances were categorised according to the World Health Organization's (WHO) AWaRe classification (Access, Watch and Reserve). RESULTS: Out of around 137,500 travellers arriving from abroad, 406 (0.30%) were inspected at routine customs inspections, of whom 57 (14%) carried antibiotics, corresponding to 643 DDDs. Inspected travellers from outside the EEA more often carried antibiotics than those within EEA (p < 0.001). More than one-third of the antibiotics were classified as 'Watch' according to the AWaRe classification. CONCLUSION: We found that 14% of inspected international air travellers carried antibiotics. These antibiotics may be used without medical guidance, raising health risks and the risk of AMR. The findings highlight a potential need for public education and/or strengthened regulatory measures.