Trends in fluoroquinolone prescribing in UK primary and secondary care between 2019 and 2023

Fluoroquinolones are important antibiotics but have associations with a number of adverse outcomes. A recent (January 2024) decision by the UK drug regulator, the Medicines and Health Regulatory Authority (MHRA), restricted systemic use of these antibiotics to when 'absolutely necessary'. One stated reason for the ban was the failure of previous guidance (2019, 2023) to reduce prescribing, with the MHRA stating there had been 'no change in prescribing' of fluoroquinolones in relation to guidance.

We evaluated the trend in prescribing of fluoroquinolones and comparator antibiotics using national data for all primary care practices in England from 2019 to 2023. We calculated the percent change in prescribing of fluoroquinolones using linear regression, comparing with other antibacterials. We also performed analysis on secondary care prescribing and included hospital inpatient stay data.

In primary care, there was a negative trend in fluoroquinolone item dispensing, with a 4.2% reduction in items dispensed per year (95% CI -5.2% to -3.3%; P = 6 × 10-13). This occurred despite no change in overall antibacterial prescription and no decrease in comparator antibiotics. Secondary care data showed stable prescription of fluoroquinolones, but comparator antibiotics increased, leading to relatively fewer prescriptions compared with other agents.

There was a reduction in fluoroquinolone prescribing in England in absolute and relative terms between 2019 and 2023 in primary care, and absolute terms in secondary care. These findings do not support the MHRA's claim that there has been no change in prescribing in response to warnings.