There is still room for improvement when it comes to prescribing antibiotics in outpatient settings. As part of the Strategy on Antibiotic Resistance (StAR), various tools have been developed for doctors for this purpose.
The fact that sparing and proper use of antibiotics slows the development of resistance and preserves long-term antimicrobial effectiveness is nothing new. The data from the systematic monitoring of antibiotic resistance by ANRESIS show that the proportion of antibiotic-resistant bacteria for certain dangerous pathogens has been increasing in Switzerland over the last 15 years. The main reason is the frequent, and in some cases inappropriate, use of antibiotics worldwide. The efficacy of treatments is reduced as a result – and this is a growing public health problem.
On the right track – with room for improvement
In human medicine today, 85 percent of antibiotics are prescribed in outpatient settings. Switzerland has a relatively low overall antibiotic consumption (Figure 1). However, there are differences between the language regions. More antibiotics are prescribed in the French- and Italian-speaking parts of Switzerland than in the German-speaking part.
Figure 1: Antibiotic consumption in outpatient settings in various European countries and the language regions of Switzerland in 2019. DDD = Defined Daily Doses. Sources: European Center for Disease Control / IQVIA-sale data for Switzerland (Swiss Antibiotic Resistance Report 2020).
Data on antibiotic consumption from the Swiss pharmaceutical association pharmaSuisse and the Sentinella reporting system show that there is also potential for improvement when it comes to selecting antibiotics.
Antibiotics with a problematic profile
Around 80 percent of antibiotic prescriptions for children are for respiratory tract infections. The recommended (simple) penicillins or aminopenicillins are not always used in these cases. Macrolides, which have a problematic profile as regards selection of resistance, are prescribed too often to treat respiratory tract infections.
Across all age groups, the extensive use of fluoroquinolones is problematic (Figure 2). These are still prescribed in over 20 percent of all urinary tract infections, although they are not indicated by the clinical evidence. And even in acute bronchitis, the most common form of infection of the lower respiratory tract, antibiotics are still prescribed, contrary to prescribing guidelines.
Figure 2: Proportion of various antibiotic classes in prescriptions by GPs for the most important indications. Analysis of data on antibiotic prescriptions in the FOPH’s Sentinella reporting system. Source: Swiss Antibiotic Resistance Report 2020
Targeted information for doctors
To educate doctors about the most common causes for inappropriate antibiotic prescribing, the Federal Office of Public Health joined forces with professional associations and other stakeholders as part of StAR to produce various tools on the proper use of antibiotics. These include prescribing guidelines, current resistance data in the INFECT application, decision-making aids on antibiotic dispensing and fact sheets for patients. The targeted information for doctors is based on the data from the monitoring of antibiotic consumption and prescriptions.
Tools on the correct dispensing of antibiotics
The StAR aims to promote proper prescribing in Switzerland in order to maintain the effectiveness of antibiotics in humans and animals. As part of StAR, the FOPH has worked with a number of professional associations and other stakeholders to develop various tools for primary care providers on the proper use of antibiotics.
Prescribing guidelines: The Swiss Society for Infectious Diseases (SSI) regularly develops and publishes guidelines that enable doctors to optimise their use of antibiotics in line with the latest scientific findings. These can be downloaded via the following link: ssi.guidelines.ch.
Users can add their own suggestions or ask questions using a comment function and thereby further improve the guidelines.
Latest resistance data and guidelines on INFECT: The latest resistance data are clearly and intuitively presented on the INFECT application produced by ANRESIS, the Swiss Centre for Antibiotic Resistance. Thus, it supports antibiotic use that is matched to the local resistance situation and linked to the SSI prescribing guidelines. INFECT can be downloaded from infect.info and is available as an app for Android and iOS devices.
General information and the latest trends can also be found at anresis.ch.
Antibiotic resistance fact sheet for patients: This fact sheet, produced by the FMH (Swiss Medical Association), pharmaSuisse and the FOPH, contains simple, understandable information and recommendations on taking antibiotics and explains the reasons why an antibiotic may not be necessary for certain infections. It also includes general information about antibiotics and antibiotic resistance. The fact sheet is available in 11 languages and can be used in connection with a consultation. The fact sheet and companion products (explanatory video, poster) can be ordered free of charge from correct-use-of-antibiotics.ch.
Decision-making aids on antibiotic prescribing in practice and quality circles: BIHAM, the Institute of Primary Health Care, has produced three evidence-based medical information tools and decision-making aids designed to help doctors and their patients jointly decide on antibiotic prescribing. Simple, understandable graphics show the advantages and disadvantages of treatment with and without antibiotics for tonsillopharyngitis, otitis media in children and uncomplicated urinary tract infections in women. These resources are ideally suited for use as thought-provoking training aids in quality circles. They can be down-loaded from biham.unibe.ch/entscheidhilfen.
