Antibiotic use in adult outpatients in Switzerland in relation to regions, seasonality and point of care tests

Abstract

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.

Trends and Seasonal Variation in Outpatient Antibiotic Prescription Rates in the United States, 2006 to 2010

“…Seasonal variation in the prescribing of antibiotics has been reported in Europe (16,27), Canada (28), and Israel (29) and, recently, in the United States (15). In the European and Canadian studies, the increase in antibiotic use in the winter months ranged from 21% to 42% (16,(27)(28)(29), in similarity to the results found here.…”

Seasonal Variation in Penicillin Use in Mexico and Brazil: Analysis of the Impact of Over-the-Counter Restrictions

“…A low seasonal variation together with a low use has been connected to appropriate use of antibiotics and low antimicrobial resistance rates (2,9,10). In the present study, Mexico and Brazil showed seasonal variations in the use of penicillins with a higher use in autumn and winter than in summer.…”

“…An interesting finding in the previous evaluation was that seasonal variation appeared to change after the restrictions took place, but this was not explored in more detail. Seasonal variation in antibiotic use has been associated with short-term lowering of resistance rates in the United States (7) and Israel (8); moreover, low seasonal variation has been related to appropriate-use profiles in Europe (9,10). Furthermore, it has been suggested that a better understanding of seasonal variation of antibiotic prescribing can be useful in the design of interventions to reduce inappropriate use of antibiotics (11).…”

Antibiotic prescribing and expenditures in outpatient adults in Greece, 2010 to 2013: evidence from real-world practice

“…In the US, the top five list of prescribed antibiotics included azithromycin, amoxicillin, amoxicillin/clavulanic acid, ciprofloxacin and cefalexin in 2010 [24], which is similar to our results. In Switzerland, amoxicillin and amoxicillin/clavulanic acid were the most used antibiotics for outpatients, with fluoroquinolones and macrolides the second and third most prescribed antibiotics in 2007 [15]. In Germany most common antibiotics consumed were penicillin/ amoxicillin, followed by tetracyclines and newer macrolides (roxithromycin, azithromycin and clarithromycin) in 2003 [17].…”

“…A thorough understanding of antibiotic prescribing patterns can help policy makers identify areas where potentially unnecessary costs can be avoided. Although data on antibiotic prescribing patterns are available for several European countries [15][16][17][18][19][20][21][22], such data are limited for Greece [13].…”