Use of oral fluoroquinolones in France between 2014 and 2023: a nationwide drug utilization study.

Objectives: This study describes fluoroquinolone (FQ) use and trends in France from 2014 to 2023, amid efforts to curb resistance and adverse effects. Methods: A nationwide observational study was conducted using data from the French National Health Insurance Database. All individuals with at least one reimbursed outpatient prescription for oral FQs between 2014 and 2023 were included. Annual cross-sectional data described prescriptions, user demographics and prescriber specialties. Trends and variations in FQ use were assessed by percent changes and compound annual growth rates. Age- and sex-standardized incidence rates (IRs) of FQ use were calculated. Results: FQ use declined by 50% from 2014 to 2023, with users dropping from 3.5 to 1.7 million and prescriptions from 4.8 to 2.2 million. Users mean age increased from 54.8 to 58.2 years, and the female proportion fell from 68% to 51%. FQ use dropped by 40% in those aged 60+  and 60% in younger individuals. Standardized IRs dropped from 54.9 to 25.6 per 1000 person-years. From 2014 to 2023, ofloxacin, ciprofloxacin, levofloxacin and moxifloxacin use decreased by 40%, 22%, 5% and 72%, respectively. Norfloxacin and lomefloxacin use dropped by 86% and 79% from 2014 to 2019, the year their reimbursement ended. General practitioners were the primary prescribers, accounting for 82.9% of prescriptions in 2023, followed by urologists-nephrologists (6.1%), ophthalmologists (1.6%), otolaryngologists (1.2%) and gynaecologists (1.1%). Conclusions: FQ use in France has declined significantly over the past decade, driven by awareness efforts and guideline changes, but remains high compared with other European countries, highlighting the need for ongoing stewardship.