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Ambulatory Care

In the outpatient sector in Switzerland, approximately 4.5 million packages of antibiotics are sold yearly. That’s more than one package per household.

Antibiotic consumption in the outpatient sector has been constant in recent years.

The total consumption of antibiotics for systemic use (ATC group J01) in the outpatient sector, summed up to 7.6 defined daily doses (DDD) per 1000 inhabitants per day in 2020. Antibiotic prescriptions in the outpatient sector have remained relatively constant in all regions in recent years. The sharp decline in 2020 could be explained by the Covid-19 pandemic1. Higher antibiotic consumption levels in the French- and the Italian-speaking parts of Switzerland may be caused by characteristic prescription cultures in different linguistic regions2.

References

[1] Laura M King et al. Trends in US Outpatient Antibiotic Prescriptions During the Coronavirus Disease 2019 Pandemic, Clinical Infectious Diseases, Volume 73, Issue 3, 1 August 2021, Pages e652–e660
[2] Filippini M. et al. Socioeconomic determinants of regional differences in outpatient antibiotic consumption: evidence from Switzerland. Health Policy. 2006. Aug;78(1):77–92. 10.1016/j.healthpol.2005.09.009

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Prescriptions of antibiotics, which are reserved for limited indications (WATCH Group) are decreasing.

The World Health Organization (WHO) has developed a classification system for antibiotics which divides existing antibiotics into three categories: Access, Watch and Reserve (“AWaRe”)1. Antibiotics from the “Access” category should be preferred in general due to their effectiveness and their moderate contribution to the development of resistances compared with other antibiotics. The “Watch” category includes antibiotics which are only indicated for a limited number of infections, while “Reserve” antibiotics are only used as a last resort. Outpatient sales of “Access” antibiotics have been largely stable, “Watch” group sales have decreased in recent years and “Reserve” Antibiotics are generally not used in the outpatient sector.  The WHO has defined a target of at least 60% of total consumption for the access group within a country. Since 2018, this target has been achieved annually in the outpatient sector in Switzerland.

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Different antibiotics are prescribed according to age

Penicillins with an extended spectrum (namely amoxicillin) were the antibiotic group most commonly used among children aged less than two years (52% of the total antibiotic consumption in 2020) and between 2–11 years (38%), whereas penicillins associated with beta-lactamase inhibitors were the most frequently used antibiotics in the age groups 18–64 (25%) and > 65 (23%). Seniors aged 65 and over were relatively high consumers of fluoroquinolones (17%) of their total antibiotic consumption).

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