Indication-related misuse of oral fluoroquinolones in adults by general practitioners in France
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≥20years 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≥75years. 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.
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BibTeX
@article{dilange2026indicationrelated,
title = {{Indication-related misuse of oral fluoroquinolones in adults by general practitioners in France}},
author = {Lisa Dilange and Karima Hider-Mlynarz and Daniele Saade and Marie-Joëlle Jabagi and Marion Bertrand and Mahmoud Zureik},
journal = {Therapies},
year = {2026},
month = nov,
doi = {10.1016/j.therap.2026.04.001},
url = {https://hal.science/hal-05849873v1},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Indication-related misuse of oral fluoroquinolones in adults by general practitioners in France
AU - Lisa Dilange
AU - Karima Hider-Mlynarz
AU - Daniele Saade
AU - Marie-Joëlle Jabagi
AU - Marion Bertrand
AU - Mahmoud Zureik
PY - 2026
DA - 2026/11/03
JO - Therapies
DO - 10.1016/j.therap.2026.04.001
UR - https://hal.science/hal-05849873v1
AB - 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≥20years 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≥75years. 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.
SN - 0040-5957
SN - 1958-5578
ER -