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Published on: August 30, 2018
Indication-related misuse of oral fluoroquinolones in adults by general practitioners in France
Lisa Dilange1, Karima Hider-Mlynarz1, Daniele Saade2
1EPI-PHARE Scientific Interest Group in Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), 93285 Saint-Denis, France.
Background:
Fluoroquinolones (FQ) are broad-spectrum antibiotics effective against various infections. However, their use has been progressively restricted by guidelines due to safety concerns, leading to repeated reassessments of their indication. Despite a marked decline in prescriptions, misuse remains a concern. This study aimed to assess FQ prescribing indications in general practice in France and analyse their evolution between 2014 and 2023 in light of changing guidelines.
Methods:
We conducted a descriptive observational study using data from the THIN® (The Health Improvement Network) database, managed by CEGEDIM-GERS DATA. This European database collects anonymized electronic health records from private practitioners in seven countries, including France since 2014. In 2023, the French panel included over 3 million patients and approximately 2000 general practitioners (GPs). Available data include administrative and medical information. Oral FQ prescriptions for patients aged≥20years were analyzed in 2014, 2019 and 2023 for compliance with five frameworks: marketing authorization (MA), SPILF 2015 (French Infectious Diseases Society), HAS 2016 (French National Authority of Health) and EMA 2018/2019 (European Medicines Agency). Results were stratified by sex, age, molecule and indication category.
Results:
FQ prescriptions by GPs declines by 59% between 2014 and 2023. Compliance varied by reference: approximately 75% according to MA and SPILF versus less than 25% with more recent guidelines (HAS 2016 and EMA 2018/2019). Compliance was lower in women and patients aged≥75years. In 2023, the largest misuse was observed for urinary and prostate infections (from approximately 94% to 24%) due to changes affecting uncomplicated urinary tract infections in women. For respiratory or ear nose and throat (ENT) infections, compliance remained low (20-40%) across all references.
Conclusions:
Despite decreasing FQ use in general practice, many prescriptions remain non-compliant with updated recommendations, highlighting a persistent gap between clinical practices and evolving guidelines.
Insights
Despite reduced fluoroquinolone (FQ) antibiotic prescriptions, many general practitioners still misuse FQ for infections, failing to adhere to updated safety guidelines. This highlights a critical gap in antibiotic stewardship.
Area of Science:
- Pharmacology
- Infectious Diseases
- Public Health
Background:
- Fluoroquinolones (FQ) are broad-spectrum antibiotics with significant safety concerns, leading to guideline restrictions and reassessments.
- Despite declining prescriptions, FQ misuse persists, necessitating an evaluation of prescribing practices.
Purpose of the Study:
- To assess fluoroquinolone prescribing indications in French general practice.
- To analyze the evolution of FQ prescribing patterns between 2014 and 2023 in relation to updated guidelines.
Main Methods:
- A descriptive observational study utilized anonymized electronic health records from the THIN® database in France (2014-2023).
- Oral FQ prescriptions for patients aged ≥20 years were analyzed for compliance with marketing authorization and multiple guideline frameworks (SPILF, HAS, EMA).
Main Results:
- FQ prescriptions decreased by 59% from 2014 to 2023, but compliance with recent guidelines (HAS, EMA) remained low (<25%).
- Misuse was highest for urinary and prostate infections, with compliance dropping significantly for uncomplicated urinary tract infections in women.
- Compliance was lower in women and elderly patients (≥75 years), and consistently low for respiratory and ENT infections (20-40%).
Conclusions:
- A significant gap persists between current fluoroquinolone prescribing practices and updated clinical guidelines in French general practice.
- Despite reduced FQ use, non-compliance remains a concern, indicating a need for improved antibiotic stewardship and guideline implementation.
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