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 2,000 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.