The national “One Health” action plan of the Antibiotic Resistance Strategy was published in 2024. It describes Switzerland’s strategy to combat antibiotic resistance over the next four years and, among other things, defines targets for antibiotic consumption in human medicine. The goal is to reduce total antibiotic consumption by 4% by 2027 compared with the reference year 2019.
In 2024, total antibiotic consumption (hospital and outpatient care, ATC code J01) amounted to 11.1 defined daily doses (Defined Daily Doses, DDD) per 1,000 inhabitants per day. This represents a slight increase of 2.8% compared with 2023. To achieve the action plan’s target by 2027, this value must be reduced to below 10.2 DDD per 1,000 inhabitants per day.
Eighty-seven percent of antibiotics were prescribed in the outpatient sector. In Switzerland, antibiotic consumption varies by language region: it is higher in the French- and Italian-speaking regions than in the German-speaking region.
The ESAC-Net (European Surveillance of Antimicrobial Consumption Network), coordinated by the European Centre for Disease Prevention and Control (ECDC), collects and analyses data on antibiotic consumption in EU/EEA countries. In a European comparison, Switzerland’s total antibiotic consumption in both the outpatient and inpatient sectors falls within the moderate to low range.
The World Health Organization (WHO) has introduced a classification system for antibiotics that divides them into three categories: “Access”, “Watch” and “Reserve” (“AWaRe”). Antibiotics in the “Access” category should generally be preferred, as they are effective and contribute only moderately to the development of resistance compared with other antibiotics. The “Watch” category includes antibiotics intended for a limited number of indications and associated with a higher likelihood of promoting resistance; they are therefore a focus of programmes for appropriate antibiotic use and surveillance. Antibiotics in the “Reserve” category should be used exclusively as a last treatment option.
According to the WHO, at least 60% of total antibiotic consumption should come from the “Access” group. The Swiss “One Health” action plan of the Antibiotic Resistance Strategy sets a more ambitious target of 69% by 2027. The share of antibiotics in this group has increased in recent years, but remains below the target value of 69%.
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Total consumption of systemically used antibiotics (ATC code J01) in the outpatient sector in 2024 was 9.7 defined daily doses (Defined Daily Dose, DDD) per 1000 inhabitants per day. During the years of the COVID-19 pandemic, a marked decline was observed. In 2024, antibiotic consumption in the outpatient sector returned to a level that was even slightly above the pre-pandemic level. This is probably attributable to the particularly pronounced Mycoplasma pneumoniae epidemic in Switzerland last winter.
Penicillins were the most frequently used antibiotic class in the outpatient sector in 2024, accounting for 39.8% of total antibiotic consumption. They were followed by macrolides, lincosamides and streptogramins (14.7%, ATC code J01F), tetracyclines (14.0%, ATC code J01A), fluoroquinolones (8.0%, ATC code J01MA), other antibiotics (6.9%, ATC code J01X), sulfonamides and trimethoprim (6.0%, ATC code J01E), and other beta-lactam antibiotics than penicillins (including cephalosporins; 5.4%, ATC code J01D).
The World Health Organization (WHO) has introduced a classification system for antibiotics that divides them into three categories: “Access”, “Watch” and “Reserve” (“AWaRe”). Antibiotics in the “Access” category should generally be preferred, as they are effective and contribute only moderately to the development of resistance compared with other antibiotics. The “Watch” category includes antibiotics intended for a limited number of indications and associated with a higher likelihood of promoting resistance; they are therefore a focus of programmes for appropriate antibiotic use and surveillance. Antibiotics in the “Reserve” category should be used exclusively as a last treatment option.
According to the WHO, at least 60% of total antibiotic consumption should come from the “Access” group. The Swiss “One Health” action plan of the Antibiotic Resistance Strategy sets a more ambitious target of 69% by 2027. The share of antibiotics in this group has increased in recent years, but remains below the target value of 69%.
In Switzerland, the share of antibiotics in the “Access” group exceeded the 60% threshold set by the WHO for the first time in 2019. This is mainly attributable to a decline in the use of antibiotics from the “Watch” group, particularly fluoroquinolones, in outpatient care. After a continuous increase over several years, the proportion of “Access” antibiotics stabilised in 2024, but remains below the target value of 69% to be achieved by 2027.
According to data from the Sentinella network, the majority of antibiotics in the outpatient setting are prescribed to treat acute respiratory tract infections and urinary tract infections. About every second antibiotic prescribed by general practitioners is used for an acute respiratory tract infection, and about every fourth for a urinary tract infection. Among paediatricians, almost nine out of ten antibiotic prescriptions are for acute respiratory tract infections.
Penicillins with an extended spectrum (namely amoxicillin) were the antibiotic group most commonly used among children aged less than two years (58% of the total antibiotic consumption in 2021) and between 2–11 years (41%), whereas penicillins associated with beta-lactamase inhibitors were the most frequently used antibiotics in the age groups 18–64 (26%) and > 65 (23%). Seniors aged 65 and over were relatively high consumers of fluoroquinolones (17%) of their total antibiotic consumption (Bar-Chart).
There are relatively strong differences in the prescription of antibiotics for different age groups. For example, in the French-speaking region of Switzerland, for children under 2 years of age, penicillins with extended spectrum (amoxicillin) are mainly prescribed, whereas in the Italian-speaking region of Switzerland, the combination of amoxicillin with clavulanic acid (comb. of penicillins) is more common (Line-Chart).
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Total consumption of systemically used antibiotics (ATC code “J01”) in the Swiss hospital sector in 2024 was 55.4 defined daily doses (Defined Daily Doses, “DDD”) per 100 patient-days, based on data from the sentinel network of acute-care hospitals. Antibiotic consumption in the inpatient sector has remained relatively stable in recent years. Only small regional differences have been observed in Switzerland. Lower consumption in the Italian-speaking part of the country could be related to the absence of university hospitals there.
Accounting for almost one third of antibiotics used in Swiss hospitals, penicillins in combination with a beta-lactamase inhibitor (ATC code “J01CR”), in particular amoxicillin/clavulanic acid, were the most frequently used group of substances. Cephalosporins (ATC codes “J01DB”–”J01DE”) were also commonly used, especially cefuroxime as a second-generation cephalosporin and ceftriaxone as a third-generation cephalosporin. While most antibiotic classes show stable or slightly increasing consumption trends, the use of fluoroquinolones has declined markedly in recent years.
Classifying acute-care hospitals into small hospitals (up to 200 beds), medium-sized hospitals (200 to 500 beds) and large hospitals (more than 500 beds) shows that larger hospitals tend to have higher antibiotic consumption than smaller hospitals due to more complex cases. However, within each hospital category, antibiotic consumption can vary considerably.
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