Indication-related misuse of oral fluoroquinolones in adults by general practitioners in France - 23/05/26

Doi : 10.1016/j.therap.2026.04.001

Lisa Dilange ^a, Karima Hider-Mlynarz ^a,⁎ , Daniele Saade ^a,^b, Marie-Joëlle Jabagi ^a, Marion Bertrand ^a, Mahmoud Zureik ^a

^a EPI-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

^b Paris-Saclay University, INSERM U1018, CESP Anti-Infective Evasion and Pharmacoepidemiology Team, 75000 Paris, France

^⁎ Corresponding author. EPI-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), 143–147, boulevard Anatole-France, 93285 Saint-Denis, France EPI-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) 143–147, boulevard Anatole-France Saint-Denis 93285 France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 23 May 2026

Abstract

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 ≥ 20 years 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 ≥ 75 years. 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.

Le texte complet de cet article est disponible en PDF.

Keywords : Fluoroquinolones, Regulatory measures, Drug utilization, Misuse