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5PSQ-002 Prescribing trend of fluoroquinolones following latest EMA recommendations
  1. A Pirrone1,
  2. M Avantaggiato2,
  3. F Panzeri2
  1. 1Ats Brianza, Pharmaceutical Service, Monza, Italy
  2. 2Università Degli Studi Di Milano, Scuola Di Specializzazione In Farmacologia E Tossicologia Clinica, Milano, Italy


Background and Importance The European Medicines Agency (EMA), following a 2018 European-wide review to assess the risk of serious and disabling adverse reactions, has recommended that the use of fluoroquinolones should be restricted. In 2019, the use of these antibiotics was significantly limited. However, a subsequent study, showed that these drugs are still prescribed outside the recommended uses. For this reason the EMA, in May 2023, issued a reminder.

Aim and Objectives The aim is to analyse the prescribing trend of fluoroquinolones, following EMA’s reminder.

Material and Methods Analysis of prescription (PR) dispensed through community pharmacies, relating to the active ingredients (p.a.) classified with the anatomic, therapeutic and chemical classification (ATC) J01MA. The period considered is from 2017 to 2022. The analysed data were in the pharmaceutical service database, grouped by p.a./ATC, patient‘s age and was processed via Microsoft Excel.

Results The number of PR of p.a. analysed decreases significantly starting from 2019. Pefloxacin and pipemidic acid are no longer prescribed from 2020. Approximately 50% of the PR, per single p.a., are intended for patients aged 65 or over (302314/601603 total PR in 6 years). The most prescribed p.a. are levofloxacin (273976 total PR) and ciprofloxacin (290553 total PR); the number of PR of these two p.a., in 2021, decreased by 66% (from 74705 to 25032) and 41% (from 65980 to 38916) respectively compared to 2017. However, in 2022 there was an increase of 14% (28741 PR) for levofloxacin and 7% (41785) for ciprofloxacin, compared to the previous year. In the remaining p.a., excluding moxifloxacin, no prescribing increase was observed between 2021 and 2022.

Conclusion and Relevance The restrictions introduced by EMA aim to reduce the risk of disabling and potentially irreversible side effects linked with fluoroquinolones use, especially in the elderly population. The results suggest that the restrictions introduced in 2019 have been adopted effectively, resulting in a decrease of prescriptions up to 2021. The increase of levofloxacin, ciprofloxacin and moxifloxacin observed in 2022 could be caused by reduced prescribing attention, shortage/ineffectiveness of other antimicrobial classes, or local respiratory infections outbreak. The EMA recall released in May 2023 represents a tool to strengthen the attention about fluoroquinolones and avoid their prescription outside the recommended uses.

Conflict of Interest No conflict of interest.

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