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

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 dose...

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Bibliographic Details
Published in:Clinical microbiology and infection 2011-06, Vol.17 (6), p.855-861
Main Authors: Achermann, R., Suter, K., Kronenberg, A., Gyger, P., Mühlemann, K., Zimmerli, W., Bucher, H.C.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - administration & dosage
Antibacterial agents
Antibiotics
Antibiotics. Antiinfectious agents. Antiparasitic agents
Bacterial Infections - diagnosis
Bacterial Infections - drug therapy
Biological and medical sciences
Drug Utilization - statistics & numerical data
epidemiology
Female
Geography
Humans
Infectious diseases
Male
Medical sciences
Middle Aged
Outpatients
Pharmacology. Drug treatments
Physicians
point of care tests
Point-of-Care Systems - utilization
Practice Patterns, Physicians' - statistics & numerical data
Primary care
Primary Health Care - methods
Seasons
Switzerland
Young Adult
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Summary: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 (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 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 DDD1000pd, and varied between 7.28 and 11.33 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 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.
ISSN:1198-743X
1469-0691
DOI:10.1111/j.1469-0691.2010.03348.x