(B-126) Oral antibiotic use with focus on fluoroquinolones during 2010-2021 in four European countries: Finnish results of the HORIZON-EU project “Real4Reg”

Background: Action plans against antimicrobial resistance have aimed at reducing overall antibiotic use, and safety recommendations from regulatory authorities have targeted fluoroquinolone (FQ) use. In the Real4Reg project, we evaluate changes in FQ dispensing rates and user characteristics using nationwide data in four European countries (Denmark, Finland, Germany, Portugal). This abstract reports findings from Finland in 2010-2021.

Objectives: To determine the annual oral FQ dispensing rate, the proportion of FQ out of all dispensed oral antibiotic prescriptions and user characteristics among adult population in 2010-2021 in Finland.

Methods: A nationwide cohort of adults (age ≥ 18 years) with oral antibiotic purchases between 2010-2021 was identified from the Finnish national registers. The main outcome measure was the dispensing rate of FQ per 1000 persons which was calculated yearly during the study period and monthly between 2016-2021 to assess changes related to use restrictions placed by the European Medicines Agency in 2019. The proportion of FQ out of all dispensed oral antibiotic prescriptions in 6-month time windows during the study period was calculated. Time trends in demographic characteristics and prevalence of comorbidities (cardiovascular diseases, stroke, diabetes, asthma/chronic obstructive pulmonary disease, cancer, dementia and urinary infections) were assessed. The same statistics were calculated for cephalosporins and amoxicillin including combinations with clavulanic acid which were used as reference.

Results: Annual antibiotic dispensing rates declined during the study period (2010-2021) from 580 to 266 prescriptions per 1000 persons for all oral antibiotics and from 43 to 17 prescriptions per 1000 persons for FQs. The proportion of FQ out of all oral antibiotics remained relatively constant throughout the study (range 7.5-5.2%). Visual inspection of monthly dispensing rates in 2016-2021 does not indicate a strong impact of regulatory warnings. FQ users were older than the users of reference antibiotics (mean age at the time of dispensing 60.6 (FQs), 52.9 (cephalosporins), 51.2 (amoxicillin) during the study period). The majority of prescriptions (>60%) of all oral antibiotics were prescribed for women, but the proportion of FQ prescriptions for women decreased from 54% to 46% during the study. FQ users showed an increase in the prevalence of all studied comorbidities compared to reference antibiotics.

Conclusions: The decline in FQ use is mainly in line with decline in overall use of antibiotics. FQ users are older and have higher burden of comorbidities than users of reference antibiotics.