Human Medicine

The total consumption of antibacterial agents (ATC code J01) in Switzerland for 2024, encompassing both hospital and outpatient care, was 11.1 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 2024, consumption had returned to approximately the same levels as before the pandemic, or even higher. Notably, around 87% 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.

The WHO AWaRe (Access, Watch, Reserve) target is to ensure that 60% of total antibiotic consumption comes from the “Access” group, with a more ambitious target of 70% by 2030. In Switzerland, the relative share of “Access” antibiotics has increased in recent years; however, as of 2024, it remains below the WHO target of 70%.

In 2024, the total consumption of antibiotics for systemic use, categorized under the ATC code J01, in the outpatient sector equated to 9.7 defined daily doses (DDD) per 1000 inhabitants per day. A pronounced decrease was observed during the years of the COVID-19 pandemic.

By 2024, 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 39.8% of the total antibiotic consumption in 2024. It was followed by the consumption of macrolides, lincosamides and streptogramins (14.7%, ATC code J01F), tetracyclines (14.0%, ATC code J01A), fluoroquinolones (8.0%, ATC code J01MA), other antibacterials (6.9%, ATC code J01X), sulfonamides and trimethoprim (6.0%, ATC code J01E) and beta-lactam antibacterials other than penicillins (including cephalosporins, 5.4%, ATC code J01D).

Following a steady increase over several years, the proportion of Access group antibiotics stabilized in 2024.

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 WHO AWaRe (Access, Watch, Reserve) target is to ensure that 60% of total antibiotic consumption comes from the “Access” group, with a more ambitious target of 70% by 2030.

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, but is still below the 70% target.

In primary care, half of all antibiotics are prescribed for acute respiratory infections.

Among adult respiratory infections, antibiotics were predominantly prescribed for sinusitis, acute bronchitis, pneumonia, and streptococcal pharyngitis. For lower respiratory tract infections, the most frequently prescribed antibiotics were amoxicillin-clavulanic acid, amoxicillin, and macrolides. For lower urinary tract infections, the most commonly prescribed antibiotics included fosfomycin, nitrofurantoin, trimethoprim-sulfamethoxazole, and fluoroquinolones.

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 53.7 DDDs per 100 bed-days (using data from the sentinel network of acute care hospitals) in 2023. 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.