Fluoroquinolones in primary care, a first step for patient empowerment towards antimicrobial stewardship?

In France, patients have claimed to have suffered serious adverse effects after receiving oral fluoroquinolones. Recently, lawsuits have been filed against physicians because patients believe they were given fluoroquinolones unnecessarily without being properly informed about potential side effects. These patients claim that ‘six million people’ have been exposed to fluoroquinolones in France over 4 years (almost 10% of the French population) [ [1] Temoignage Santé: Une association de patients dénonce six millions d’empoisonnements en France en quatre ans par les fluoroquinolones. Franceinfo. 2023; https://www.francetvinfo.fr/sante/medicament/temoignage-sante-six-millions-de-personnes-ont-ete-empoisonnees-en-france-en-quatre-ans-par-les-fluoroquinolones-denonce-un-patient-desormais-handicape_5708564.htmlDate accessed: May 14, 2023 Google Scholar ]. Indeed, fluoroquinolones remain the fourth most commonly prescribed antibiotics worldwide [ [2] Van Boeckel T.P. Gandra S. Ashok A. Caudron Q. Grenfell B.T. Levin S.A. et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014; 14: 742-750https://doi.org/10.1016/S1473-3099(14)70780-7 Abstract Full Text Full Text PDF PubMed Scopus (1465) Google Scholar ], especially in primary care where misuse for minor infections or off-label use is high according to the European Medicines Agency [ [3] Pacurariu A. Flach C. Markov E. Thom L. Ly N. Layton D. Study of impact of EU label changes for fluoroquinolone containing medicinal products for systemic and inhalation use – Post-referral prescribing trends. European Medicines Agency, 2022 Google Scholar ]. Reducing the use of fluoroquinolones in these settings must be a priority, and this patient alert could be an opportunity to understand how we can improve antibiotic prescribing in primary care. Primary care physicians may find the process harsh, but could it not be the first step towards patient empowerment in antimicrobial stewardship?