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. 2025 May 27:13:Doc01.
doi: 10.3205/id000091. eCollection 2025.

(Fluoro)quinolone prescriptions for upper respiratory tract infections in the German outpatient sector: a health insurance claims analysis

Birgit Arens  1 , Helmut L'hoest  2 , Alissa Wolf  1 , Beata Hennig  2 , Ursula Marschall  2 , Irit Nachtigall  3
Affiliations

(Fluoro)quinolone prescriptions for upper respiratory tract infections in the German outpatient sector: a health insurance claims analysis

Birgit Arens et al. GMS Infect Dis. .

Abstract

Background: Acute upper respiratory tract infections (URTIs) are frequent causes of medical treatment by general practitioners (GPs). In general, these are viral and self-limiting illnesses, but antibiotics are prescribed. In Germany, fluoroquinolones are not authorised for the indications pharyngitis, laryngitis, tonsillitis and acute bronchitis due to possible serious side effects. This analysis looks at fluoroquinolone prescriptions for URTI by GPs in 2022.

Methods: Frequency of fluoroquinolone prescriptions were analysed at case level and regionally using administrative insurance data from the German health insurance company BARMER. We included patients treated in GP practices without relevant concomitant diseases.

Results: In 2022, 25% (1,197,568/4,720,786) of insured persons with upper respiratory tract infections (URTI) were prescribed antibiotics. After excluding comorbidities and other risk factors such as previous hospitalisation, the prescription rate for uncomplicated URTIs was calculated to be 6% (80,786/1,365,646). Fluoroquinolones were given in 2.4% of antibiotic prescriptions (1,951/80,786). Nationwide, 3.7% of the GPs prescribed fluoroquinolones, most frequently in the region Brandenburg with 6.6% (74/1,121).

Conclusion: This analysis showed that fluoroquinolones are still prescribed for uncomplicated URTI, which must be considered as alarming regarding the nature of the disease and the unfavourable risk-benefit profiles. There were clear regional differences in fluoroquinolone prescribing, indicating potential for improvement in the use of reserve antibiotics for uncomplicated upper respiratory tract infections.

Keywords: Germany; fluoroquinolones; general practices; health insurance data; side effects; upper respiratory tract infections.

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Conflict of interest statement

The authors declare that they have no competing interests. The Center of Excellence for Quality Assurance (Kompetenz-Centrum Qualitätssicherung, KCQ) advises the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband, GKV-SV) on questions of healthcare quality strategies at the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA).

Figures

Figure 1
Figure 1. Flowchart of analysed cases
Figure 2
Figure 2. Fluoroquinolone share of all prescribed antibiotics, displayed by diagnosis (2022)
Figure 3
Figure 3. Share of practices prescribing fluoroquinolone among all general practitioners’ practices, displayed by diagnosis (2022)
Figure 4
Figure 4. Proportion of general practices prescribing fluoroquinolone among all general practices, displayed by federal states (2022). The federal states of Bremen, Hamburg and Saarland are not shown due to the low number of people insured by the BARMER health insurance company in these regions.
Figure 5
Figure 5. Extrapolated number of fluoroquinolone treatments per 10,000 cases with acute uncomplicated upper respiratory tract infection displayed by age group (2022)
See this image and copyright information in PMC

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