The use of antibiotics is highest in primary care and directly associated with antibiotic resistance in the community. We assessed regional variations in antibiotic use in primary care in Switzerland and explored prescription patterns in relation to the use of point of care tests. Defined daily doses of antibiotics per 1000 inhabitants (DDD(1000pd) ) were calculated for the year 2007 from reimbursement data of the largest Swiss health insurer, based on the anatomic therapeutic chemical classification and the DDD methodology recommended by WHO. We present ecological associations by use of descriptive and regression analysis. We analysed data from 1 067 934 adults, representing 17.1% of the Swiss population. The rate of outpatient antibiotic prescriptions in the entire population was 8.5 DDD(1000pd) , and varied between 7.28 and 11.33 DDD(1000pd) for northwest Switzerland and the Lake Geneva region. DDD(1000pd) for the three most prescribed antibiotics were 2.90 for amoxicillin and amoxicillin-clavulanate, 1.77 for fluoroquinolones, and 1.34 for macrolides. Regions with higher DDD(1000pd) showed higher seasonal variability in antibiotic use and lower use of all point of care tests. In regression analysis for each class of antibiotics, the use of any point of care test was consistently associated with fewer antibiotic prescriptions. Prescription rates of primary care physicians showed variations between Swiss regions and were lower in northwest Switzerland and in physicians using point of care tests. Ecological studies are prone to bias and whether point of care tests reduce antibiotic use has to be investigated in pragmatic primary care trials.

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guideline and the shortly coming updated version is an appropriate time to review and compare it with other European guidelines in order to identify the main similarities and differences in key features. METHODS: We chose 14 European guidelines and compared them based on the 32 key guideline features developed by Hjelmgren et al. RESULTS: No relevant differences were found between the Hungarian and the European guidelines in tha major part (23) of the key features. The Hungarian guideline represented nearly the same methodological aspects for example in the choice of comparator, time horizon, discount rate and financial impact analysis. We appraised relevant differences in the perspective of the PE studies, preferred analytical technic (CMA, CEA, CUA, CBA), systematic review of evidences, costs to be included, preferred outcome measure and deliver utility. The QALY is the preferred health outcome measure in cost utility studies almost in every European countries, however only the English and Scottish guidelines require only EQ-5D profile to deliver utility. In the new version of the Hungarian guideline the discount rate will be changed from 5% to 3,7%, the cost-effectiveness threshold will be explicitly determined (twofold and threefold of GDP per capita) and the direct comparisons will be preferred instead of indirect comparisons. CONCLUSIONS: Generally we concluded that the Hungarian guideline published in 2002 and also the new modified version basicly require the same approach and expectations as the European ones. Change in three main things (discount rate, cost-effectivess threshold, direct comparison preference) makes our guidelines more elaborated that could help the rational decision-making. The explicitly determined cost-effectiveness threshold requires specification in the method of delivering utility in the future.

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