Human Medicine

The total consumption of antibacterial agents (ATC code J01) in Switzerland for 2023, encompassing both hospital and outpatient care, was 10.8 defined daily doses (DDD) per 1,000 inhabitants per day. In recent years, there has been a slight decline in overall antibiotic consumption, with a more significant decrease observed during the COVID-19 pandemic. However, by 2023, consumption had returned to approximately the same levels as before the pandemic, or even higher. Notably, around 85% of total antibiotic consumption occurs in the outpatient sector.

Switzerland displays varying patterns of antibiotic consumption in the outpatient sector, with higher rates seen in the French and Italian-speaking regions compared to the German-speaking region.

The European Surveillance of Antimicrobial Consumption Network (ESAC-Net), coordinated by the European Centre for Disease Prevention and Control (ECDC), collects and analyses data on antibiotic consumption from 30 EU/EEA countries. Compared to these European countries, the overall consumption of antibiotics in both the outpatient and inpatient sectors in Switzerland is comparatively low.

According to the World Health Organization, at least 60% of total antibiotic consumption should be accounted for by antibiotics from the “Access” group. In Switzerland, the relative share of antibiotic consumption in the “Access” group has increased in recent years and has been above the WHO target of 60% for the first time in 2019.

In 2022, the total consumption of antibiotics for systemic use, categorized under the ATC code J01, in the outpatient sector equated to 8.7 defined daily doses (DDD) per 1000 inhabitants per day. This represents a continued trend of declining consumption that has been observed since 2014. The decline was subtle until 2019, but during the years of the COVID-19 pandemic, a pronounced decrease in consumption was registered. By 2022, however, antibiotic consumption in the outpatient sector had returned to levels similar to those seen before the pandemic.

Penicillins are the most commonly used antibiotic category in the outpatient sector.

Consumption of penicillins ranked first among antibiotic classes, amounting to 43% of the total antibiotic consumption in 2022. It was followed by the consumption of tetracyclines (13.6%, ATC code J01A), macrolides, lincosamides and streptogramins (12.6%, ATC code J01F), fluoroquinolones (10%, ATC code J01MA), other antibacterials (7.4%, ATC code J01X), sulfonamides and trimethoprim (6.4%, ATC code J01E) and beta-lactam antibacterials other than penicillins (including cephalosporins, 6.6%, ATC code J01D).

The use of “Access” antibiotics is steadily increasing in the outpatient sector.

The World Health Organization (WHO) has developed a classification system for antibiotics which divides existing antibiotics into three categories: Access, Watch and Reserve (“AWaRe”). 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 and more prone to be a target of antibiotic resistance and thus prioritized as targets of stewardship programs and monitoring, while “Reserve” antibiotics are only used as a last resort.

The proportion of the “Access” group in Switzerland has been above the WHO target of 60% for the first time in 2019,mainly due to the decrease in the consumption of Watch antibiotics in the outpatient setting. In recent years, the percentage of “Access” antibiotics in the outpatient setting has steadily increased, while the percentage of watch antibiotics has decreased.

Antibiotics are most commonly prescribed for lower urinary tract and upper respiratory tract infections.

In 2022, general practitioners and internists issued a total of 23.1 antibiotic prescriptions per 1000 consultations. The most common reasons for prescribing antibiotics were upper respiratory tract infections and urinary tract infections. For lower respiratory tract infections, the most frequently prescribed antibiotic classes were Amoxicillin-Clavulanic acid, amoxicillin, and macrolides. For lower urinary tract infections, the most commonly prescribed antibiotics included fosfomycin, nitrofurantoin, trimethoprim-sulfamethoxazole, and fluoroquinolones. Antibiotics were predominantly prescribed for sinusitis, acute bronchitis, pneumonia, and streptococcal pharyngitis among respiratory infections.

In 2022, pediatricians issued a total of 29.4 antibiotic prescriptions per 1000 consultations. The most common reason for prescribing antibiotics in pediatric cases was upper respiratory tract infections. The most frequently prescribed antibiotics for upper respiratory tract infections were amoxicillin and amoxicillin-clavulanic acid.

Different antibiotic use depending on age group.

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).

Penicillins in combination with beta lactamase inhibitors are the most commonly used antibiotics in the inpatient sector.

The total consumption of antibiotics (ATC group J01) for systemic use in the swiss inpatient sector was 54.1 DDDs per 100 bed-days (using data from the sentinel network of acute care hospitals) in 2022. The antibiotic consumption in the inpatient sector in Switzerland has been relatively stable in recent years. Small regional differences in the consumption of antibiotics have been observed throughout Switzerland. A lower consumption in the Italian-speaking part could be explained by the fact that this part does not have a university hospital center.

With almost one third of all antibiotics used in Swiss hospitals, penicillins in combination with a beta-lactamase inhibitor (ATC code J01CR), especially amoxicillin-clavulanic acid, are the most commonly used antibiotics. Also, cephalosporins (ATC code J01DB-DE), especially the 2nd-generation cephalosporin cefuroxime or the 3rd generation-cephalosporin ceftriaxone, were widely used. While most antibiotic classes show a stable or slightly increasing consumption trend, the consumption of fluoroquinolones has decreased significantly in recent years.

“Access” antibiotics account for half of the antibiotics consumed in hospitals.

The 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.

Consumption of “Access” and “Watch” antibiotics in Swiss hospitals has remained largely unchanged in recent years. The consumption of antibiotics in the “reserve” group is low, accounting for about 1% of total consumption across the hospital.

Larger hospitals tend to have higher antibiotic use

A classification of acute care hospitals into small hospitals (up to 200 beds), medium-sized hospitals (200-500 beds) and large hospitals (over 500 beds) illustrates that due to more complex cases, larger hospitals tend to have a higher antibiotic consumption than smaller hospitals. However, the antibiotic consumption of hospitals within a hospital category can be highly variable.