Impact of risk mitigation measures on oral fluoroquinolone prescribing: a multi-site population-based Canadian cohort study
Abstract
Background Use of fluoroquinolones (FQs), broad-spectrum antibiotics, has been linked to adverse health outcomes and resulted in safety warnings by regulatory agencies worldwide. We tested the effect of Canadian risk mitigation measures (RMMs) introduced in January 2017 on FQ prescription rates. Methods We conducted a retrospective multi-site cohort study using administrative data from six Canadian provinces. The cohort included adults (18 + years) with outpatient prescriptions for four oral systemic FQs (ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin) between 2008 and 2022. Overall FQ prescription rates and percentage of FQ prescriptions for three antibiotic indications (acute bacterial sinusitis [ABS], acute exacerbation of chronic obstructive pulmonary disease [AECOPD], urinary tract infection [UTI]) were assessed before and after RMMs were introduced. Segmented generalized linear models were applied to monthly prescription rates and percentages for: (1) pre-RMM (January 2008-December 2016; reference), (2) post-RMM pre-COVID (January 2017-Feburary 2020), and (3) post-RMM within-COVID (March 2020-December 2022) segments. We estimated province-specific relative rates (RR) for the post-RMM segments and slope coefficients for pre- and post-RMM segments and their 95% confidence intervals (CIs) and pooled them using random-effects models. Results Crude annual FQ prescription rates decreased from 107.5 to 45.0 per 1,000 population over the study period; in the pre-RMM…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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