(B-103) Use of Systemic Oral Fluoroquinolones in France Between 2014 and 2023: A Nationwide Population-Based Study Using The French National Health Data System

Background: Fluoroquinolones (FQs) are broad-spectrum antibiotics prescribed to treat severe bacterial infections. Several actions have been implemented in the past decade to ensure their proper use and to limit their use, their risks of antibiotic resistance and adverse effects.

Objectives: To assess the use of systemic FQs in France and its evolution from 2014 to 2023, while considering the various awareness actions and measures implemented during this period.

Methods: We conducted a nationwide population-based study using data from the French national health insurance database (SNDS). We identified all users who received at least one reimbursed oral FQs dispensed in community pharmacies from 2014 to 2023. FQs studied were ciprofloxacin, ofloxacin, norfloxacin, lomefloxacin, enoxacin, levofloxacin and moxifloxacin. We used annual cross-sectional data to assess the evolution of number of users and FQs dispensations by sex, age groups (0-19 years old, 20-39 years old, 40-59 years old, 60-74 years old and ≥ 75 years old), region of residence and type of FQs. The identification of the specialties in the main FQs prescribers was based on the total number of prescriptions dispensed each year. Age- and sex-standardized user rates per 1000 inhabitants were also calculated for each year based on the structure of the French population in 2023.

Results: A 50% reduction in the use of FQs was observed between 2014 (4.8 million dispensations for 3.5 million users) and 2023 (2.2 million dispensations for 1.7 million users), with standardized user rates estimated at 54.9 (95%CI: [54.8; 55.0]) and 25.6 [25.6; 25.7] users per 1,000 inhabitants, respectively. The female-to-male ratio decreased from 2.08 in 2014 to 1.03 in 2023. A 40% decrease in use was observed in those aged 60 and over, and 60% in other age groups. FQs use decreased by over 50% across all regions of France, though some regional disparities remained. From 2014 to 2023, the use of ofloxacin, ciprofloxacin, levofloxacin and moxifloxacin declined by 40%, 22%, 5% and 72%, respectively. The use of norfloxacin and lomefloxacin decreased respectively by 86% and 79%, from 2014 until 2019 (year of their de-reimbursement). General practitioners are the main prescribers of FQs in France. In 2023, 82.9% of prescribers were general practitioners, 6.1% urologists-nephrologists, 1.6% ophthalmologists, 1.2% otolaryngologists and 1.1% gynecologists.

Conclusions: This national study revealed that the use of FQs in France has significantly decreased over the last decade, thanks to various actions and awareness-raising efforts aimed at reducing their inappropriate use. However, FQs are still being overused in France. Further studies are needed to investigate the misuse and adverse effects of these medications within the French population.