Swiss medical weekly最新文献

{"title":"Updated recommendations for osteoporosis treatment according to fracture risk: 2026 revision by the Swiss Association against Osteoporosis (SVGO).","authors":"Serge Ferrari, Emmanuel Biver, Elena Gonzalez-Rodriguez, Melanie Kistler-Fischbacher, Olivier Lamy, Heike Bischoff-Ferrari, Christian Meier","doi":"10.57187/5700","DOIUrl":"https://doi.org/10.57187/5700","url":null,"abstract":"<p><p>Osteoporosis remains a major public health burden in Switzerland and is still associated with a substantial treatment gap. These updated recommendations from the Swiss Association against Osteoporosis (SVGO) revise the 2020 risk-based framework by integrating advances in fracture-risk assessment, lifestyle management, anabolic therapy, treatment sequencing and treat-to-target concepts. Risk assessment should be based on Swiss Fracture Risk Assessment Tool (FRAX) probabilities, possibly refined by a FRAXplus approach. Five risk categories are retained - low, moderate, high, very high and imminent risk. Patients at imminent or very high risk should preferentially receive an anabolic-first strategy followed by antiresorptive consolidation. Within the anabolic class, romosozumab and abaloparatide may be preferred when the fastest and broadest bone mineral density (BMD) gain is needed, particularly at the hip. In high-risk patients, potent antiresorptives, i.e. bisphosphonates or denosumab, remain first line. In moderate-risk patients, lifestyle optimisation remains mandatory, and raloxifene or oral bisphosphonates are usually recommended, but in selected women with osteopenia or early osteoporosis, infrequent zoledronate emerges as a pragmatic preventive option. A treat-to-target concept based primarily on hip BMD is proposed, with reassessment after 2 years and treatment sequence chosen according to baseline BMD and urgency of fracture-risk reduction. These recommendations aim to improve implementation of fracture prevention in Switzerland while acknowledging reimbursement constraints and areas where evidence remains indirect.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5700"},"PeriodicalIF":1.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic arguments in migration and health - a call for interdisciplinary action.","authors":"Ursula Trummer, David McDaid, Anne Jachmann, Sonja Novak-Zezula, Stefan Boes, Ina Teresa Wilczewska","doi":"10.57187/5167","DOIUrl":"https://doi.org/10.57187/5167","url":null,"abstract":"<p><p>Economic considerations remain underexplored in migration and health research, despite their relevance for policy, equity and health system sustainability. This viewpoint synthesises insights from a rapid literature review, an expert survey and a workshop to explore how economic arguments are framed within scientific debates at the intersection of migration and health. Findings reveal that while cost-related aspects are frequently discussed with reference to migrants' health and healthcare utilisation, they are rarely grounded in empirical data or formal economic evaluations, and collaboration between health economists and migration health researchers remains limited. Experts emphasised the importance of understanding both the short- and long-term costs of inclusion and exclusion of migrants in healthcare systems, as well as the broader societal impacts. Strengthening interdisciplinary and interprofessional collaboration will be essential to generate robust, context-sensitive evidence that informs equitable, sustainable and human rights-based health policies.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5167"},"PeriodicalIF":1.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Desmopressin (DDAVP): indications and practicalities.","authors":"Eugenia Biguzzi, Alessandro Casini, Alessandra Bosch, Johanna A Kremer Hovinga, Lorenzo Alberio, Pierre Fontana, Anne Angelillo-Scherrer, Bernhard Gerber, Working Party Of Haemostasis Of The Swiss Society Of Haematology, Swiss Haemophilia Network","doi":"10.57187/5030","DOIUrl":"https://doi.org/10.57187/5030","url":null,"abstract":"<p><strong>Background: </strong>Desmopressin (1-deamino-8-D-arginine vasopressin, or DDAVP) is available in Switzerland for the treatment of non-severe haemophilia A and von Willebrand disease.</p><p><strong>Objective: </strong>To provide practical guidance for the use of desmopressin in patients with non-severe haemophilia A, von Willebrand disease, bleeding disorders of unknown cause and mild platelet function disorders.</p><p><strong>Methods: </strong>Based on the available literature and clinical experience in Switzerland, the Swiss Society of Haematology's Haemostasis Working Group and the Swiss Haemophilia Network worked together to reach a consensus on the use of desmopressin.</p><p><strong>Results and conclusions: </strong>Desmopressin may increase and normalise factor VIII and von Willebrand factor levels in patients with non-severe haemophilia A and von Willebrand disease and can prevent or treat bleeding in patients with bleeding disorders of unknown cause and mild platelet function disorders. A desmopressin trial is recommended to verify tolerability and identify responders, as the response to the drug is not predictable based on baseline levels of factor VIII and von Willebrand factor. Previously observed side effects and current contraindications must be carefully evaluated prior to every administration.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5030"},"PeriodicalIF":1.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of Activity-Based Funding and Patient Trajectory Managers' contributions to financial indicators and care in a Swiss General Internal Medicine Department: a retrospective study.","authors":"Andrea Rudaz, Jean-Luc Reny, Gilles Cohen, Arnaud Perrier, Gaëlle Ruchaud, Jerôme Stirnemann","doi":"10.57187/3824","DOIUrl":"https://doi.org/10.57187/3824","url":null,"abstract":"<p><strong>Background: </strong>In 2012, Switzerland introduced a new activity-based funding system (SwissDRG). In 2014, Geneva University Hospitals also introduced a new staff role, Patient Trajectory Manager (PTM), aimed at optimising patient care trajectories, hospital length of stay (LOS) and clinical documentation. The objective of the present study was to analyse the impact of the SwissDRG on quality and efficiency of care in our division. We also analysed the impact of the implementation of Patient Trajectory Managers on efficiency.</p><p><strong>Methods: </strong>We analysed 59,621 hospitalisations between 2007 and 2019 using statistical description with an ARIMA model, complemented by interrupted time-series analysis based on SARIMA intervention models. The primary outcome was LOS; secondary outcomes included average length of stay (ALOS), Cost Weight, discharge destination, difference vs theoretical ALOS, readmissions and mortality.</p><p><strong>Results: </strong>Following SwissDRG implementation, median LOS decreased from 10 days (2007-2011) to 8 days (2012-2019; p <0.001), with a higher proportion of patients discharged home (70.2% vs 75.4%, p <0.001). Interrupted time-series analyses confirmed a significant immediate reduction in LOS at the time of SwissDRG introduction, followed by a sustained downward trend. No significant effects were observed on 18-day readmissions or in-hospital mortality. After the introduction of PTMs, LOS continued to decrease and remained below predicted trajectories derived from pre-PTM trends, but interrupted time-series analyses did not identify an additional significant abrupt level reduction. However, significant post-intervention slope changes were observed for LOS-related efficiency indicators, indicating a sustained monthly reduction over time rather than an immediate effect. The period after PTM implementation was also associated with a reduced gap between observed and theoretical DRG LOS and fewer LOS upper-outliers, without adverse effects on readmissions or mortality.</p><p><strong>Conclusion: </strong>There was a significant decrease in LOS across the three successive periods of observation. The introduction of activity-based funding through SwissDRG was associated with a major and immediate significant reduction in hospital LOS. However, subsequent organisational interventions through the implementation of Patient Trajectory Managers did not produce an additional causal level significant reduction in LOS but was associated with sustained improvements in efficiency-related trends, optimisation of DRG-related performance and stabilisation of care processes over time, without compromising patient outcomes.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"3824"},"PeriodicalIF":1.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Negative impact of a 1-month period of night shifts on mental and physical health among Swiss internal medicine residents.","authors":"Amandine Berner, Clement P Buclin, Delphine Courvoisier, Jean-Luc Reny, Nicolas Garin, Jacques Serratrice, Thomas Agoritsas, Pauline Darbellay Farhoumand","doi":"10.57187/4027","DOIUrl":"https://doi.org/10.57187/4027","url":null,"abstract":"<p><strong>Study aims: </strong>To assess the impact of short periods of night shifts on: sleep quality and sleep medication intake, burnout scores, care-related regrets experience and coping mechanisms of internal medicine residents.</p><p><strong>Methods: </strong>Before-after analysis of data from the Nightshift project, a repeated measures evaluation of the clinical activity and burden of night shifts, conducted between October 2019 and March 2020 in the Division of General Internal Medicine of Geneva University Hospitals (Clinicaltrials.gov: NCT04123015). Forty-one residents of 55 (74.5%) screened for eligibility were included before their first night shift. They completed an anonymous e-survey before and after a 1-month period of night shifts, assessing sleep quality, sleep medication intake, burnout scores using the Copenhagen Burnout Inventory (CBI), the number and intensity of care-related regrets using the Regret Intensity Scale (RIS-10) and resident's coping abilities with the Care-related Regret Coping Scale for Health-care Professionals (RCS-HCP).</p><p><strong>Results: </strong>After the 1-month period of night shifts, sleep medication intake had increased from 7.3% to 24.4%, p = 0.02. At baseline, 31 (75.6%) of the 41 participating residents (65.9% women) scored low in all three dimensions of burnout. For each burnout dimension, at least 30% of residents had an increase in score ≥5 points. Moderate or high levels of burnout remained stable for professional burnout (24.4%), but increased for personal (17.1% to 26.9%) and patient-related burnout (4.8% to 14.6%) though none of these changes were statistically significant. All of the 25% of residents who experienced regrets on actions taken during their shift were women. They reported overall limited coping abilities, e.g. 80% displayed frequent use of negative maladaptive strategies to deal with regret.</p><p><strong>Conclusions: </strong>Even short periods of night shifts can have a significant impact on residents' mental and physical health. A high proportion of residents had increased burnout scores, a factor known to be correlated with job dissatisfaction and absence due to sickness. Sleep medication intake increased 3-fold, suggesting sleep issues. Respondents reported frequent care-related regrets and poor coping abilities, with use of maladaptive strategies, known to be associated with poor sleep and job resignation. As stricter regulations on daily working hours are proposed, the frequency of on-call duties will inevitably increase. Understanding the implications of short periods of night shifts is not only essential for shaping residency programme policies and for shift scheduling, but also for informing training programmes on non-pharmacological sleep management, burnout prevention and the development of positive regret-coping strategies.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"4027"},"PeriodicalIF":1.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a national Smarter Medicine guideline on outpatient proton-pump inhibitor prescription in Switzerland: a nationwide interrupted time-series analysis.","authors":"François Panosetti, Dorian Bachmann, Xavier Richard, Daniel Genné","doi":"10.57187/5204","DOIUrl":"https://doi.org/10.57187/5204","url":null,"abstract":"<p><strong>Background: </strong>Proton-pump inhibitors (PPI) are a key treatment for gastro-oesophageal disease, but their frequent overprescription leads to potential adverse effects and an economic burden. In this retrospective study, we investigated the effect of a Smarter Medicine guideline published in May 2014 by the Swiss Society of General Internal Medicine, which recommended that general practitioners should avoid \"long-term treatment of gastrointestinal symptoms with proton-pump inhibitors without titrating to the lowest effective dose needed\".</p><p><strong>Methods: </strong>An interrupted time-series analysis was performed using a Seasonal AutoRegressive Integrated Moving Average (SARIMA) model, which was validated through a Bayesian Model Averaging algorithm with changepoint detection. National PPI sell-in data was provided by IQVIA and covered 100% of oral and intravenous PPIs distributed in Switzerland from 2009 to 2019. The main outcome was the monthly number of oral PPI defined daily doses (DDD) per 100,000 inhabitants aged ≥20 years. A regression analysis was conducted to estimate pre-guideline trend, post-guideline level change and post-guideline slope change. Using Bayesian Model Averaging, the probability of changepoint occurrence over time was calculated without predetermined intervention dates. Oral PPI DDDs were used as a surrogate for outpatient prescriptions, while intravenous PPI DDDs served as a control in Bayesian Model Averaging.</p><p><strong>Results: </strong>Following guideline publication, a significant post-guideline downward trend of oral PPI DDDs was observed (slope change, p <0.001). Bayesian analysis of oral PPI DDDs supported a single changepoint with 92% probability, most likely occurring within 2 years after guideline publication (79% summed changepoint occurrence probability). For intravenous DDDs, the probability of a single changepoint dropped to 41%, with only 29% summed probability for the same period.</p><p><strong>Conclusions: </strong>A significant downward trend in PPI oral DDDs was observed after the Smarter Medicine guideline publication, suggesting that primary care guidelines have the potential to induce change in prescribing behaviour.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5204"},"PeriodicalIF":1.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First reported human Castellaniella defragrans bacteraemia: a case report.","authors":"Morgane Nédellec, Titouan Cerruti, Damien Jacot, Gilbert Greub, Malik Benmachiche","doi":"10.57187/5401","DOIUrl":"https://doi.org/10.57187/5401","url":null,"abstract":"<p><p>Castellaniella defragrans is an environmental Gram-negative, non-fermenting β-proteobacterium that is not known as a human pathogen. Here, we report the first documented case of C. defragrans bacteraemia in an 82-year-old man with monoclonal B-cell lymphocytosis, subsequently diagnosed with chronic lymphocytic leukaemia, who presented with fever, confusion and clinical signs of sepsis. Blood cultures showed sustained growth of C. defragrans for 7 days. Imaging revealed pulmonary consolidations and mediastinal infiltration suggestive of mediastinitis. Further investigations did not identify a clear additional infectious focus. In addition, an immunological evaluation revealed severe cellular and humoral immunosuppression. Antimicrobial therapy with high-dose meropenem led to bacteraemia clearance and progressive clinical improvement. Treatment was completed with oral sulfamethoxazole-trimethoprim for a total of five weeks. This case highlights the potential of environmental microorganisms to cause severe infections in immunocompromised hosts.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5401"},"PeriodicalIF":1.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of reporting notifiable infectious diseases - the Swiss reporting system.","authors":"Michelle Raess, Annora Celant, Mirjam Mäusezahl","doi":"10.57187/5508","DOIUrl":"10.57187/5508","url":null,"abstract":"<p><p>The structured processes of clinical medicine and epidemiology are closely aligned, with disease reporting serving as the critical interface between individual patient care and population-level public health action. In Switzerland, mandatory reporting of communicable diseases forms the backbone of national infectious disease surveillance and relies on coordinated contributions from clinicians and laboratories. The Swiss reporting system is regulated by an ordinance that defines notifiable diseases, reporting criteria and strict timelines. It encompasses severe diseases, outbreak-prone infections, and endemic or vaccine-preventable conditions, and is continuously updated to reflect evolving epidemiological threats. Accurate case classification depends on the integration of both clinical and laboratory data; incomplete reporting compromises data quality and can lead to misclassification and biased epidemiological conclusions. In recent years, reporting compliance - particularly for clinical notifications - has declined significantly. This deterioration in data completeness limits the ability to detect outbreaks, assess trends and implement timely and targeted public health interventions. Contributing factors include administrative burden, limited awareness of reporting obligations and insufficient understanding of the public health value of reporting. High-quality reporting is essential for multiple public health functions: enabling rapid containment measures such as contact tracing and isolation, supporting outbreak detection through statistical surveillance and genomic analysis, informing national health policies and vaccination strategies, and facilitating research. Surveillance data are routinely analysed and disseminated via national dashboards and international collaborations. In conclusion, although reporting imposes additional demands on clinicians, it remains a fundamental component of effective public health practice. Strengthening reporting compliance and data quality is critical to ensuring timely interventions, reducing disease burden and maintaining resilient health systems. Improved digital solutions may alleviate reporting burdens; however, sustained clinician engagement and recognition of their role in public health are indispensable.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5508"},"PeriodicalIF":1.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out-of-hospital cardiac arrest management in the Swiss canton of Valais: a retrospective study on first responders' response and automated external defibrillator efficacy.","authors":"Athiththan Kanthasamy, Patrizio Pascale, Grégoire Girod","doi":"10.57187/4761","DOIUrl":"https://doi.org/10.57187/4761","url":null,"abstract":"<p><strong>Study aims: </strong>Cardiac arrest is a condition with a high mortality rate, with most cases occurring outside hospital. First responders (defined as public responders in our study) play an increasingly important role in management through the early initiation of cardiopulmonary resuscitation and defibrillation. Several studies have shown that the involvement of public responders can result in faster initiation of resuscitation and increased survival. This study evaluated the management of out-of-hospital cardiac arrest by public responders and the effectiveness of the FRED-PA1 automated external defibrillator (AED) available in the canton of Valais, Switzerland.</p><p><strong>Methods: </strong>This was a retrospective study including consecutive cases of out-of-hospital cardiac arrest occurring between January 2021 and December 2023 in the canton of Valais. Response times of public responders and emergency medical services (EMS) were evaluated, along with initial rhythms, survival, and the performance and safety of the available AEDs.</p><p><strong>Results: </strong>A total of 107 patients were included in the study. In 68% of cases, a public responder arrived at the scene first, with a significantly shorter interval between emergency call and on-site arrival compared with EMSs (p = 0.019). Ventricular fibrillation was more frequent in the EMS group than the public responders group (35 vs 23%) (non-significant [NS]). Survival on arrival at hospital was 19% in the public responder group and 24% in the EMS group (NS). Survival to hospital discharge was 9.6% in the public responder group and 15% in the EMS group (NS). Concerning the AEDs, the rhythm recognition algorithm was deemed to be effective and consistent with current recommendations.</p><p><strong>Conclusion: </strong>This retrospective study demonstrates the key role played by public responders, who are frequently the first to arrive at the scene of out-of-hospital cardiac arrests. The FRED-PA1 AED algorithm meets the standards in the literature. However, ongoing prospective studies will highlight and optimise the role of public responders in out-of-hospital cardiac arrests.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"4761"},"PeriodicalIF":1.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An unusual cause of a necrotic bullous skin lesion: a case report.","authors":"Katharina Knapp, Stephanie Holzer, Marius Schlienger","doi":"10.57187/5215","DOIUrl":"https://doi.org/10.57187/5215","url":null,"abstract":"<p><strong>Background: </strong>Tularaemia is a zoonotic infection uncommon in Switzerland, but its incidence is increasing. Thus, tularaemia should also be considered in returning travellers with compatible exposure history. We report a case of ulceroglandular tularaemia presenting with a necrotic bullous skin lesion.</p><p><strong>Case presentation: </strong>A man in his 30s presented with a necrotic bullous lesion on the right palm, accompanied by ipsilateral axillary and supraclavicular lymphadenopathy. Eleven days prior, during a stay in Canada, he developed an itchy skin lesion and reported direct contact with a hare carcass five days before symptom onset. He initially received antibiotic therapy with a cephalosporin, which did not result in clinical improvement. A swab obtained from the lesion tested positive for Francisella tularensis subsp. tularensis by polymerase chain reaction (PCR), and serology confirmed the result.</p><p><strong>Treatment and outcome: </strong>Antibiotic therapy was initially switched to doxycycline (100 mg twice daily), but discontinued after 6 days because of a sore throat suggestive of oesophageal irritation. Ciprofloxacin (500 mg twice daily) was subsequently administered for 10 days, during which the lesion, lymphadenopathy and general symptoms resolved rapidly. This case highlights the importance of thorough exposure history and the early consideration of tularaemia in patients with necrotic skin lesions and regional lymphadenopathy, particularly when there is no response to standard antibiotic therapy. Early diagnosis allows for appropriate antimicrobial treatment and favourable outcomes.</p>","PeriodicalId":22111,"journal":{"name":"Swiss medical weekly","volume":"156 ","pages":"5215"},"PeriodicalIF":1.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}