Use of oral fluoroquinolones in France between 2014 and 2023: a nationwide drug utilization study

Abstract

Objectives: This study describes fluoroquinolone (FQ) use and trends in France from 2014 to 2023, amid efforts to curb resistance and adverse effects.

Methods: A nationwide observational study was conducted using data from the French National Health Insurance Database. All individuals with at least one reimbursed outpatient prescription for oral FQs between 2014 and 2023 were included. Annual cross-sectional data described prescriptions, user demographics and prescriber specialties. Trends and variations in FQ use were assessed by percent changes and compound annual growth rates. Age- and sex-standardized incidence rates (IRs) of FQ use were calculated.

Results: FQ use declined by 50% from 2014 to 2023, with users dropping from 3.5 to 1.7 million and prescriptions from 4.8 to 2.2 million. Users mean age increased from 54.8 to 58.2 years, and the female proportion fell from 68% to 51%. FQ use dropped by 40% in those aged 60+ and 60% in younger individuals. Standardized IRs dropped from 54.9 to 25.6 per 1000 person-years. From 2014 to 2023, ofloxacin, ciprofloxacin, levofloxacin and moxifloxacin use decreased by 40%, 22%, 5% and 72%, respectively. Norfloxacin and lomefloxacin use dropped by 86% and 79% from 2014 to 2019, the year their reimbursement ended. General practitioners were the primary prescribers, accounting for 82.9% of prescriptions in 2023, followed by urologists-nephrologists (6.1%), ophthalmologists (1.6%), otolaryngologists (1.2%) and gynaecologists (1.1%).

Conclusions: FQ use in France has declined significantly over the past decade, driven by awareness efforts and guideline changes, but remains high compared with other European countries, highlighting the need for ongoing stewardship.

Figure 1.

Distribution of oral FQ users and prescriptions and their CAGR from 2014 to 2023. ‘Users’ include all oral FQ users in terms of annual total number; ‘Prescriptions’ include all oral FQ prescriptions dispensed in terms of annual total number; the ‘CAGR’ measures the average annual change in FQ use in terms of number of users and number of prescriptions dispensed from 2014 to 2023, assuming a constant rate of decrease over time.

Figure 2.

Trends in age- and sex-standardized IR of FQ users per 1000 person-years in France from 2014 to 2023.

Figure 3.

(a) Distribution of FQ users by gender and their CAGR from 2014 to 2023. (b) Distribution of FQ users by age categories from 2014 to 2023.

Figure 4.

Sex- and age-standardized IRs of oral FQ use by region per 1000 person-years for the years 2014, 2019 and 2023.

Figure 5.

(a) Distribution of oral FQ prescriptions according to their prescriber status (private practitioners versus hospital-based practitioners) and their CAGR from 2014 to 2023. (b) Distribution of oral FQ prescriptions dispensed by private specialists (excluding GPs) from 2014 to 2023 categorized by medical specialty. Other medical specialties include general surgery, gastroenterology and hepatology, pulmonology, orthopaedics–traumatology–rheumatology and rehabilitation, internal medicine, haematology–oncology, cardiovascular, neuropsychiatry, infectious diseases, venereology and allergology, intensive medical care, anatomy–cytology–pathology, paediatrics, stomatology–dentistry, geriatrics, laboratory director physicians, endocrinology and metabolism, nuclear medicine, medical genetics, public health and social medicine, forensic medicine and medical expertise and emergency medicine.