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There currently are no mandatory vaccines in Switzerland. However, Swiss federal legislation allows for vaccination mandates in settings where the risk of transmission to vulnerable groups is high, such as healthcare professionals (HCPs) working with vulnerable patients. Since HCPs are trusted information sources, a priority population for COVID-19 vaccination, and potentially subjected to mandates, we investigated HCP perspectives on mandates.A national online survey was administered to HCPs (October 2020-March 2021), including vaccine mandates questions concerning patients (measles) and HCPs (influenza). We qualitatively investigated HCP mandate perspectives through: (1) 34 interviews with HCPs, HCP professional society representatives, and health authorities; (2) a focus group discussion (FGD) with complementary medicine (CM) and biomedical physicians, and Swiss Federal Vaccination Commission members.1933 participants (496 physicians, 226 pharmacists, 607 nurses, 604 midwives) responded to the survey. Quantitative results show all professional groups preferred shared parent-HCP measles vaccine decisions (65%, 54%, 50%, 48%, respectively; p for trend 0.001). Midwives (87%) and nurses (70%) preferred individual influenza vaccination decisions for HCPs, while physicians (49%) and pharmacists (44%) preferred shared employee-employer decisions (p for trend 0.001). Physicians (p .001) and pharmacists (p .01) with CM training favored individual influenza vaccination decisions. Qualitative results show general HCP opposition to vaccine mandates, mainly because participants argued how other approaches, such as HCP training and better information, could encourage uptake. Arguments against COVID-19 mandates included insufficiently documented long-term safety/efficacy data. From participants' perspectives, mandated vaccination should be used as a last resort. Some participants expressed fear that with mandates, notably for influenza and COVID-19, some HCPs might leave their jobs. HCPs were unsure what vaccine mandates would concretely look like in practice, particularly regarding sanctions for non-compliance and enforcement.In Switzerland, HCPs generally were opposed to vaccination mandates. Clarity and guidance are needed from health authorities to better inform discussions around vaccine mandates.

This article examines the relationships between biomedicine, complementary and alternative medicine (CAM) and parents' vaccination decision-making in Switzerland. Our empirical evidence sheds light on an understudied phenomenon-parents switching from one doctor to another provider (often one offering CAM services) around issues that arise during vaccination consultations. This is important to understand since CAM is used by 25%-50% of the Swiss population and is integrated into the Swiss health-care system when offered by biomedically trained medical doctors with additional CAM training. Qualitative data gathered from in-depth semi-structured interviews with parents (N = 30) and ethnographic observations of vaccination consultations (N = 16 biomedical consultations, N = 18 CAM consultations) demonstrate how there was not always a clear-cut, direct relationship between (non)vaccination and parents' use of CAM and/or biomedicine. Borrowing from Hirschman (Exit, voice, and loyalty: Responses to decline in firms, organizations, and states, Harvard Univ. Press, 1970), we frame our analysis by using the concepts of exit, voice and loyalty to describe parents' provider selection and vaccination decision-making process, although only four families in the sample described switching solely because of vaccination-related issues. Findings add to vaccine decision-making literature by describing and analysing the underdiscussed provider-switching phenomenon and by demonstrating the importance of parents' experiences of trust, affect and choice in vaccination consultations as they pursue the best health outcomes for their children.

Background Pediatric integrative medicine, combining conventional and complementary medical approaches for children and adolescents, is an integral part of the health care system in Switzerland. However, there is still a lack of complementary and integrative medicine topics in training and continuing educational programs. For the first time on a national level, the 2021 annual conference of the Swiss Society of Pediatrics was entirely dedicated to the topic of integrative medicine. Methods Using a cross-sectional online survey, this study investigated congress participants’ evaluation and feedback with the aim to assess whether the program had met their objectives and to get empirical data on their attitude, expectations and needs regarding pediatric complementary and integrative medicine. Descriptive methods were used to present the results. Results Among 632 participants of the conference, 228 completed the evaluation form (response rate 36%). The overall feedback about the congress and the main theme of pediatric integrative medicine was clearly positive. The majority of respondents had achieved their educational objectives including complementary and integrative medicine issues. 82% were motivated to learn more about complementary and integrative medicine and 66% were stimulated to integrate complementary therapies into their professional practice. Conclusion This study from Switzerland confirms the interest in integrative medicine among pediatricians and supports the need for pre- and postgraduate pediatric training on topics related to complementary and integrative medicine. Developing and adapting training and continuing medical education based on evaluations of participant feedback can promote professional development and improve patient care for the benefit of physicians and patients.

Kinder sollen bei jeder Impfung vor allem einen personlichen Nutzen haben. ­Wegen dem meist milden und komplikationslosen Verlauf im Fall einer COVID-19-­Ansteckung und der noch ungenugend dokumentierten Sicherheit der COVID-Impfungen empfehlen wir Zuruckhaltung und eine differenzierte individuelle Beurteilung bei der Empfehlung der COVID-19-Impfung fur Kinder und Jugend­liche.

Pour toute vaccination, les enfants doivent avant tout presenter un benefice ­personnel. En raison de l’evolution generalement benigne et sans complication d’une infection a la COVID-19 et de la securite encore insuffisamment documentee des vaccins contre cette maladie, nous preconisons une certaine reserve et une evaluation individuelle differenciee lors de la recommandation de la vaccination COVID-19 pour les enfants et adolescents.

La mononucleose infectieuse aigue est un probleme frequent en medecine de ville. Dans 90% des cas, la mononucleose est due au virus Epstein-Barr (EBV) – pour de nombreux medecins, «EBV» et «mononucleose» sont synonymes. Le diagnostic n’est pas toujours facile, et certaines personnes atteintes ne presentent pas d’autres symptomes que la fatigue.

Die akute infektiose Mononukleose, oft auch Pfeiffersches Drusenfieber genannt, ist ein haufiges Problem in der Praxis. In 90% wird die Mononukleose durch das Epstein-Barr-Virus (EBV) verursacht – fur viele Arztinnen und Arzte sind «EBV» und «Pfeiffer» synonym. Die Diagnose ist nicht immer ganz einfach, zum Teil haben die Betroffenen ausser Mudigkeit wenig andere Symptome, und die Serologie ist nicht immer eindeutig.

Vaccine hesitancy (VH) is a complex and context-specific phenomenon that is linked to under-immunization and poses challenges to immunization programs. The Parent Attitudes about Childhood Vaccines (PACV) is an instrument developed to measure VH. We translated the PACV into three languages (German, French and Italian) and administered it to 1388 Swiss parents. We used exploratory factor analysis (EFA) to confirm the scale sub-domains, Cronbach's alpha to assess internal consistency reliability, and Mokken scale analysis (MSA), to explore unidimensionality of each language version. We determined to construct validity by linking parental PACV score to children's immunization status for the first dose of measles vaccine. For the 15-item PACV, EFA extracted three sub-domains in German and French and four sub-domains in Italian. Cronbach's alpha was >0.8 across the three languages, and MSA produced a 13-item German, 14-item French, and 11-item Italian PACV. EFA and MSA of the short version PACV extracted a single factor and scale with Cronbach's alpha >0.7 in all three language versions. VH was significantly associated with non-timely receipt of the first dose of measles in all languages (odds ratio of 20.7, 21.3, and 8.3 for German, French, and Italian languages, respectively). The translated and revised PACV-15 versions are valid and reliable instruments for VH measurement. The structure and reliability of the short version of the PACV was as good as the long version. Our results suggest that the PACV can be used to measure parental VH outside the US in the validated languages.

De nombreux medecins generalistes et pediatres sont regulierement confrontes aux questions de leurs patients quant aux mesures qu’ils recommanderaient, en plus de la vaccination contre la grippe saisonniere, pour la prevention et le traitement des maladies grippales, y compris la grippe et desormais la COVID-19. En medecine complementaire notamment, il existe un grand nombre de methodes eprouvees a cet effet, que nous souhaitons presenter dans cet article.

Die Grippeimpfung gilt allgemein als sicherste, einfachste und wirksamste Methode, um Influenza zu vermeiden. Haus- und Spitalarzt/-innen und das Pflegepersonal stehen der Grippeimpfung allerdings zum Teil kritisch gegenuber, was den Nutzen bei alteren Personen und bei sich selbst betrifft.

La vaccination contre la grippe est generalement consideree comme la methode la plus sure, simple et efficace pour prevenir la grippe. Toutefois, les medecins generalistes, les medecins hospitaliers et le personnel infirmier sont parfois critiques a l’egard du vaccin contre la grippe en ce qui concerne le benefice qu’il presente pour les personnes âgees et pour eux-memes.

No validated measures of vaccine hesitancy (VH) for youth vaccination currently exist. We adapted the Parent Attitudes about Childhood Vaccines survey (PACV-15) for use in youth to create the version Youth Attitudes about Vaccines survey (YAV-14 and YAV-5), then translated it into three languages (German, French, and Italian). We administered the YAV-14 to 1,003 youth aged 15-26 years in Switzerland. We used exploratory factor analysis and Mokken scale analysis to explore the psychometric properties, Cronbach's alpha to investigate the reliability for the YAV-14 and the YAV-5, but we only report results of the YAV-5 analysis here. We determined construct validity by logistic regression of the association between youth VH as measured by the YAV-5 and non-receipt of the first human papillomavirus (HPV) vaccine dose. EFA produced a single scale in German and French while two factors were obtained in Italian. All language versions fit the Mokken scale models with medium-scale strength. There was a significant association between VH and HPV vaccine non-receipt for the full sample (odds ratio (OR); 1.93, 95% confidence interval (CI); 1.31-2.85). Language-stratified analyses found a significant association between VH and non-immunization in the German-language sample. Our results demonstrate that the German version of YAV-5 is a valid and reliable scale for identifying vaccine hesitant youth regardless of sex, and the French version is a valid and reliable scale for identifying vaccine hesitant female youth. Further validation is needed for Italian and French-speaking male youth.

ObjectivesIdentifying factors associated with human papillomavirus (HPV) vaccine uptake is essential for designing successful vaccination programmes. We aimed to examine the association between vaccine hesitancy (VH) and HPV vaccine uptake among male and female youth in Switzerland.DesignWith a cross-sectional study, an interview-based questionnaire was used to collect information on sociodemographic factors, vaccination records and to measure the prevalence of VH using the Youth Attitudes about Vaccines scale (YAV-5), a modified version of the Parent Attitudes about Childhood Vaccinations survey instrument.Setting and participantsEligible male and female participants, 15–26 years of age, were recruited through physicians’ offices and military enlistment in all three language regions of Switzerland. Of 1001 participants, we included 674 participants with a vaccination record available (415 males and 259 females) in this study.Primary and secondary outcome measuresThe outcome was uptake for HPV vaccine (having received ≥1 dose of HPV vaccine). Covariates were VH, sex, age and other sociodemographics.Results151 (58%) female and 64 (15%) male participants received ≥1 dose of HPV vaccine. 81 (31%) female and 92 (22%) male participants were VH (YAV-5-Score >50). The odds for being unvaccinated were higher for VH women than non-VH women, adjusted OR=4.90 (95% CI 2.53 to 9.50), but similar among VH and non-VH men, OR=1.90 (95% CI 0.84 to 4.31). The odds for being unvaccinated were lower for younger men (born on or after 1 July 2002) than older men (born before 1 July 2002), OR=0.34 (95% CI 0.14 to 0.81), but we found no association between age and vaccine uptake for female youth, OR=0.97 (95% CI 0.48 to 1.97).ConclusionsVH was associated with lower HPV vaccine uptake in female youth but not male youth in our study population in Switzerland. Our findings suggest that issues other than VH contribute to HPV underimmunisation in male youth in Switzerland.

Die «Grippe»-Welle im Winter 2020/2021 wird zur Herausforderung fur Haus- und Spitalarzt/-innen. COVID-19 kann klinisch nicht von einer Influenza und anderen «grippe-ahnlichen» Erkrankungen unterschieden werden – die wichtigste Differenzialdiagnose der «Grippe» ist COVID-19. Die PCR-Diagnostik aus dem Nasopharynx bleibt die sensitivste Diagnosemethode fur COVID-19. Antigen-Schnelltests erlauben es, infektiose Personen rasch zu erkennen und so die Dauer ihrer Infektiositat abzukurzen (Resultat liegt innert 15–20 Minuten vor; ein negatives Resultat schliesst COVID-19 nicht aus).

L'épidémie de «grippe» de l'hiver 2020/2021 sera un défi pour les médecins généralistes et les médecins des hôpitaux. La COVID-19 ne peut pas être cliniquement distinguée de la grippe et d'autres syndromes grippaux – le diagnostic différentiel le plus important de la «grippe» étant la COVID-19. La PCR du nasopharynx reste la méthode de diagnostic la plus sensible pour la COVID-19. Les tests rapides permettent de détecter rapidement les personnes infectieuses et donc de réduire la ­durée de leur contagiosité (résultat disponible en 15–20 minutes; un test rapide négatif n'exclut pas la COVID-19)

Limiting antibiotic use is urgent due to increasing antibiotic resistance and the long-term implications of a disturbed microbiome. Data on antibiotic use of physicians integrating conventional and complementary medicine show that a significant reduction of antibiotic use in primary care is possible. In the setting of non-complicated infections in out-patient medicine, open dialogue with the patient, recognizing the importance of fever and reducing antipyretic use are general measures that can help reduce patients' concerns, and increase their trust in a well-functioning immune system and a treatment approach without antibiotics. Accumulating evidence suggests that complementary medicine strategies are useful in the management of common infections without antibiotics.Vu l’augmentation de la résistance aux antibiotiques et les conséquences qu’implique, à long terme, un microbiote perturbé, il est urgent de limiter leur consommation. Les données obtenues chez les médecins intégrant médecines conventionnelle et complémentaire montrent un recours aux antibiotiques diminué dans les soins primaires. Une communication adaptée, la compréhension de l’importance de la fièvre et la diminution de la prise d’antipyrétiques sont autant d’étapes clés pouvant aider les patients à surmonter leurs craintes, à renforcer leur confiance en leur système immunitaire et en un traitement sans antibiotiques en cas d’infections simples. Un nombre croissant d’études démontre ainsi que les outils de la médecine complémentaire peuvent contribuer à la gestion des infections courantes sans antibiotiques.

Based on evidence and experience, pediatric integrative medicine uses conventional and complementary therapies in an interprofessional approach to optimally support health and development of children and adolescents. Switzerland has a high standard of child health care including complementary medicine. Many pediatricians and family physicians offer an integrative approach to their patients based on additional trainings in complementary medicine, which ensures a full and competent medical care. The Swiss Interest Group for Integrative Pediatrics of the Swiss Society of Pediatrics deals with all questions relating to complementary and integrative medicine in pediatrics including the organization of training events and the coordination of research projects.Basée sur l’évidence et l’expérience, la pédiatrie intégrative utilise des thérapies conventionnelles et complémentaires dans une approche interprofessionnelle, pour promouvoir de manière optimale le développement et la santé des enfants et adolescents. La Suisse dispose d’un niveau élevé de soins pédiatriques incluant la médecine complémentaire. De nombreux pédiatres et médecins de famille offrent une approche intégrative aux patients, basée sur des formations supplémentaires en médecine complémentaire, ce qui garantit une prise en charge large et compétente. Le Groupe d’intérêt suisse pour la pédiatrie intégrative de la Société suisse de pédiatrie traite de toutes les questions relatives à la médecine complémentaire et l’approche intégrative en pédiatrie, y compris l’organisation des formations et la coordination de la recherche.

Novel strategies are needed to address vaccine hesitancy (VH), which correlates with complementary and alternative medicine (CAM). In Switzerland, CAM providers play important roles in vaccine counseling of vaccine hesitant (VH) parents, and traditional vaccination messaging tends to overlook CAM provider perspectives. In the setting of a Swiss national research program on VH, our key strategy has been to work together closely with CAM providers. To assess the feasibility of generating educational human papillomavirus (HPV) vaccine materials that would interest VH healthcare providers (HCPs), we invited four CAM providers to co-author two HPV vaccine review articles for general practitioners. We conducted thematic analysis of CAM provider comments to identify patterns that could complement and improve vaccination messaging from CAM perspectives. We identified several themes and generated an inventory of CAM provider messaging recommendations related to language use, presentation of background information, nuanced statements regarding HPV vaccine efficacy and safety, and communication tools that would be important to VH HCPs. Contrary to our initial expectations, and in an inclusive, respectful atmosphere of open dialogue, we were able to productively finalize our manuscripts. In the opinion of the CAM co-authors, the manuscripts effectively considered the communication needs and perspectives of VH HCPs. Engaging with CAM providers appears to be a feasible and innovative avenue for providing vaccine information and designing communication tools aimed at VH healthcare providers.

This article reports on our qualitative inquiry into the meanings biomedically trained doctors in Switzerland attach to treating vaccine hesitant (VH) and underimmunized patients. With support from social science literature on ‘good’ and ‘bad’ patients and doctors, we explore how both doctors and patients cross the boundaries of these conceptual categories in situations involving vaccine hesitancy and underimmunization. The doctors we interviewed (N = 20) and observed (N = 16 observations, subsample of 6 doctors from the interview sample) described how they screened, measured, and diagnosed patients' levels of vaccine hesitancy. Our results emphasize the meanings doctors associated with counseling hesitant patients, especially while managing their own professional responsibilities, legitimacy, and reputations among colleagues and patients. Doctors' discourses constructed the figure of ‘problem patients,’ characterized through their (potential) non-adherence to vaccination recommendations, desire for lengthy consultations and individualized counseling, and dogmatic ideologies running contra to biomedicine. Discussions around the dilemmas faced by doctors in vaccination consultations brings to the fore several key, yet underdiscussed, paradoxes concerning VH, patient-doctor relationships, and the constructs of ‘good’/‘bad’ doctors and patients. These paradoxes revolve around expectations in Western societies for ‘good’ patients to be autonomous health-information seekers and active participants in clinical encounters, which research shows to be the case for many VH and underimmunizing individuals. However, in the eyes of many vaccination advocates and proponents of biomedical approaches, VH patients become ‘bad’ patients thru their risk of non-adherence, which has implications for the population at large. In these consultations, doctors find themselves conflicted around the expectations to promote vaccination while, at the same time, being active listeners and good communicators with those who question their biomedical training and legitimacy. Understanding these paradoxes highlights the need to better support HCPs in addressing VH in clinical practice.

ObjectivesThe aim of this study was to better understand parental trust in and satisfaction with information sources and medical providers regarding decision making about childhood vaccines.SettingThe study was part of a Swiss national research programme investigating vaccine hesitancy and underimmunisation.ParticipantsWe conducted qualitative interviews with 37 providers and 30 parents, observed 34 vaccination consultations, and then conducted quantitative surveys with 130 providers (both complementary and alternative medicine (CAM) oriented and biomedically oriented) and 1390 parents.Main outcome measuresParticipants’ vaccination information sources used in their decision-making process, parents’ trust in and satisfaction with these sources and providers.ResultsBased on the Parent Attitudes about Childhood Vaccines scale, we considered 501 parents as vaccine-hesitant (VH) and 889 parents as non-VH. Whereas both groups mentioned providers as the most trusted source of information, VH-parents were less likely to mention paediatricians (N=358 (71%) vs N=755 (85%)) and public health authorities (N=101 (20%) vs N=333 (37%)) than non-VH-parents. VH-parents were more likely to have consulted another provider (N=196 (39%) vs N=173 (19%)) than non-VH-parents, to express less satisfaction with both their primary (N=342 (82%) vs N=586 (91%)) and other providers (N=82 (42%) vs N=142 (82%)) and less trust in their primary (N=368 (88%) vs N=632 (98%)) and other providers (N=108 (55%) vs N=146 (84%)). VH-parents were less likely to be satisfied with their biomedical primary provider than non-VH-parents (100 (69%) vs 467 (91%)). However, when the primary provider was CAM-oriented, there were similar levels of satisfaction among both groups (237 (89%) VH-parents vs 118 (89%) non-VH-parents). All differences were significant (pConclusionsWhile the provider remains the main information source, VH parents turn to additional sources and providers, which is likely related to VH parents being rather dissatisfied with and distrusting in obtained information and their provider.EthicsThe local ethics committee (Ethikkommission Nordwest- und Zentralschweiz, EKNZ; project ID number 2017-00725) approved the study.

Mycoplasma pneumoniae is a significant cause of pneumonia in school-aged children and young adults. We report a case of neonatal M. pneumoniae pneumonia in a preterm child manifesting in the first hours of life. Vertical transmission was demonstrated by the detection of M. pneumoniae in inflamed placental tissue indicating chorioamnionitis.

Chaque annee en automne, lorsque la «saison des refroidissements» commence, nous sommes a nouveau confrontes a un grand nombre d’infections des voies respiratoires. Dans ce contexte, de nombreux patients demandent quelles sont les possibilites permettant de prevenir ou traiter les infections des voies respiratoires en renforcant le systeme immunitaire. Des preuves solides existent pour certains produits qui presentent un effet immunostimulant.

Ziel dieses Artikels ist es aufzuzeigen, wie die Streptokokken-Angina auch in der Schweiz meist ohne Antibiotika erfolgreich behandelt werden kann.

Cet article a pour objectif de montrer comment l’angine a streptocoques peut, en Suisse aussi, le plus souvent etre traitee avec succes sans antibiotiques.

Die HPV-Impfung wurde weltweit ab 2006 (Schweiz: 2008) eingeführt; sie hat eine deutliche Reduktion von Zervixdysplasien bewirkt. Nun gilt es, auch die Knaben und jungen Männer zu impfen (Impfempfehlung seit 2015), denn 20–30% der HPVassoziierten Karzinomdiagnosen betreffen Männer (v.a. Oropharynx-, Anal- und Peniskarzinome). Die Impfung schützt auch gegen die häufigen und psychisch belastenden Genitalwarzen und ihre Sicher heit ist gut etabliert. Ein neuer Neunfachimpfstoff steht seit 1.1.2019 zur Verfügung.

La vaccination HPV a ete introduite en 2006; elle a entraine une nette reduction des dysplasies du col de l’uterus. Il convient de vacciner aussi les garcons, car 20‒30% des carcinomes associes au HPV concernent des hommes.

By learning from CAM physicians, we could improve the quality of our vaccination counselling, and health authorities should be able to avoid unnecessary vaccination mandates in Switzerland.

Complementary and alternative medicine (CAM) providers' roles in parents' decision-making about vaccinations for their children have only recently begun receiving research attention, despite studies showing CAM to be used by 25-50% of the population in Western countries. This article examines how CAM practitioners discuss vaccinations with parents in Switzerland, with a focus on childhood vaccinations and human papillomavirus (HPV) vaccinations. We describe how the CAM providers we interviewed (N = 17) and observed during vaccination consultations (N = 18 observations with 5 providers) employed individualized approaches to vaccination. Triangulation of qualitative evidence from interviews and observations allowed us to analyze their discourses and descriptions of experiences (i.e. what they said) and their practices in situ (i.e. what they did). Evidence gathered shows that practitioners framed vaccination decisions as choices at individual and family levels rather than focusing on public health benefits and consequences. They articulated their perspectives in terms of personal clinical experiences and parents' wishes, concerns, and contexts. Such findings challenge recurring narratives depicting CAM providers as categorically anti-vaccination and suggest that approaches to address vaccine hesitancy in clinical practice could benefit from communication and relational approaches similar to those demonstrated by participants in this study. Such approaches include taking time to understand parents' wishes, involving them in vaccination decisions, and taking their concerns seriously.

In Switzerland, complementary medicine (CM) is officially recognised within the healthcare system and mainly practised in an integrative manner, in conjunction with conventional medicine. As in other countries, there is high demand for and use of CM with children. However, there has so far been no research into the attitude towards, training in and offer of CM among paediatricians in Switzerland. Our study addresses this gap by investigating these topics with an online survey of paediatricians in Switzerland.METHODS: We conducted a national online survey using a 19-item, self- reporting questionnaire among all ordinary and junior members of the Swiss Society of Paediatrics (SSP). A comparison of the study sample with the population of all paediatricians registered with the Swiss Medical Association (FMH) allowed an assessment of the survey’s representativeness. The data analysis was performed on the overall group level as well as for predefined subgroups (e.g. sex, age, language, workplace and professional experience).RESULTS: 1890 paediatricians were approached and 640, from all parts of Switzerland, responded to the survey (response rate 34%). Two thirds of respondents were female, were aged between 35 and 55 years, trained as paediatric generalist and worked in a practice. Apart from young paediatricians in training, the study sample was representative of all Swiss paediatricians. 23% had attended training in CM, most frequently in phytotherapy, homeopathy, acupuncture/traditional Chinese medicine (TCM) and anthroposophic medicine. 65% were interested in CM courses and training. 16% provide CM services to their patients and almost all paediatricians (97%) are asked by patients/parents about CM therapies. More than half of the responding paediatricians use CM for themselves or their families. 42% were willing to contribute to paediatric CM research.CONCLUSIONS: In a representative sample of paediatricians in Switzerland, their personal attitude towards CM is positive, emphasised by great interest in CM training, a willingness to contribute to CM research and a high rate of paediatricians who use CM for themselves and their families. In contrast, the percentage of paediatricians offering CM is currently rather low despite strong demand for CM for children. This study provides key pointers for the future development of complementary and integrative medicine for children in Switzerland.

Introduction Reducing antibiotic use is a global priority, but the extent to which antibiotic prescriptions can be reduced in children hospitalized for community-acquired pneumonia is unknown. This study aimed to analyse the prescribing experience from a facility with a long-standing practice of restrictive antibiotic use. Methods We conducted a retrospective analysis of children from birth to 18 years, hospitalized for pneumonia at an integrative medicine hospital in Germany. Antibiotic prescription rate and clinical outcomes were analyzed. The Moreno Bacterial Pneumonia Score, a composite laboratory, clinical and radiologic score, was applied to estimate the proportion of viral and bacterial pneumonia. Results 252 pneumonia episodes were included, with 172 categorized as probably viral and 80 as bacterial pneumonia. Antibiotic prescription rate was 32 % overall, 26 % for presumed viral and 51 % for presumed bacterial pneumonia. Children with probable bacterial pneumonia who were managed with antibiotics had higher CRP values than those managed without antibiotics (p Conclusions The observed antibiotic prescription rate of 32 % was much lower than rates reported in the literature - 88–98 %. Children were safely managed with a restrictive antibiotic prescription strategy when physicians judged this to be appropriate. Our findings suggest that a delayed prescription strategy for childhood pneumonia deserves further study. Trial registration the study was registered at clinicaltrials.org, NCT03256474.