Trends in fluoroquinolone prescribing in UK primary and secondary care between 2019 and 2023.

Introduction Fluoroquinolones are important, widely used antibiotics but have associations with a significant number of adverse outcomes. A recent (January 2024) decision by the UK drug regulator, the Medicines and Health Regulatory Authority (MHRA), restricted systemic use of these antibiotics to when only absolutely necessary with immediate effect. One stated reason for the ban was the failure of previous guidance (2019, 2023), to impact prescribing, with the 2023 MHRA Drug Safety Update stating there had been ″no change in prescribing″ of fluoroquinolones in relation to guidance. Methods We evaluated the trend in prescribing of fluoroquinolones and comparator antibiotics using national data for all primary care practices in England from 2019 to 2023. We calculated the percent change in prescribing of fluoroquinolones using linear regression, comparing with other antibacterials Analyses were then performed at the integrated care board (ICB) level. We also performed a similar analysis on secondary care prescribing and included hospital inpatient stay data. Results In primary care, there was a clear negative trend in fluoroquinolone (particularly ciprofloxacin) item dispensing, with a 4.2% reduction in items dispended per year, 95% confidence interval, CI (-5.2% ; -3.3%, p = 6 x 10-13). This occurred despite no change in overall antibacterial prescription (+2% -0.56% ; +4.6%, p = 0.12) and no decrease in comparator antibiotics. These occurred across nearly all (97/101) ICBs. Secondary care data showed stable prescription of fluoroquinolones, but other comparator antibiotics increased, leading to relatively fewer prescriptions compared to other agents. Conclusions There was a marked reduction in fluoroquinolone prescribing in primary care in England in both absolute terms and relative to other antibiotics between 2019 to 2023. Relative reductions have occurred in secondary care. Funding Wellcome Trust (222894/Z/21/Z) ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement FHs time was funded by the Wellcome Trust (222894/Z/21/Z) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All data used in this analysis is publicly available. No ethics approval was therefore required. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes We used R v 4.31 for analyses, and used the tidyverse package for data wrangling and plotting.22 All code is available at https://github.com/gushamilton/floroquinolone, and the analysis is completely replicable by running the same code locally. Regression was performed using the linear regression model in R, while some plots fitted splines via ggplot.