Gesundheitswesen 2010; 72 - V57
DOI: 10.1055/s-0030-1266231

Determinants of outpatient antibiotic use in Switzerland in relation to regions, seasonality and point of care tests: A representative analysis of national differences

H Bucher 1, R Achermann 2, A Kronenberg 3, P Gyger 2, K Muhlemann 3, W Zimmerli 4
  • 1Universitätsspital Basel, Basel
  • 2Division of Health Economics and Health Policy, Helsana, Zürich
  • 3Institut für Infektionskrankheiten, University Hospital and University of Bern, Bern
  • 4Medizinische Universitätsklinik Liestal, Liestal

Background: 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 and antibiotic resistance in Switzerland, and explored prescription patterns in relation to the use of point of care tests. Methods: Defined daily doses of antibiotics per 1000 inhabitants (DDD1000pd) 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 by WHO. We present ecological associations by use of descriptive and regression analysis. Results: We analysed data from 1,067,934 adults representing 17.2% of the Swiss population. The rate of outpatient antibiotic prescriptions in the entire population was 8.5 DDD1000pd, and varied between 7.3 and 11.3 DDD1000pd for Northwest Switzerland and the Lake Geneva region. DDD1000pd 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 DDD1000pd showed higher seasonal variability in antibiotic use, higher antibiotic resistance and lower use of all point of care tests. In regression analysis for all antibiotics the use of any point of care test was consistently associated with less antibiotic prescriptions. For example, for amoxiclline-clavulanate and fluoroquinolones use of point of care tests was associated with 21% (95% CI 16% –26%) and 32% (95% CI 28% –45%) reduction in prescriptions of these antibiotics. Conclusions: Prescription rates of primary care physicians showed variations between Swiss regions and were lower in German speaking regions and in physicians using point of care tests. Such tests may offer interesting perspectives to limit antibiotic use, and should be further evaluated in primary care.