22 Dec Use of Oral Fluoroquinolones in Canada: A Drug Utilization Study Update
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Use of Oral Fluoroquinolones in Canada: A Drug Utilization Study Update
HC0073
Overview
What is the issue?
- In January 2017, Health Canada issued a risk communication to restrict the use of fluoroquinolone antibiotics due to their potentially persistent and disabling side effects. Updates to the product labels were also made.
- It is unknown if fluoroquinolone utilization patterns have changed since these regulatory actions were implemented.
- At the request of Health Canada, we updated our previous drug utilization study to determine if further regulatory actions are needed.
What was the aim of the study?
- The overall objective was to describe fluoroquinolone utilization trends from 2008 to 2022 and to assess the impact of the risk minimization measures introduced in 2017.
How was the study conducted?
- We conducted a retrospective cohort study using administrative health databases from 6 provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario, and Saskatchewan).
- The study population consisted of all individuals with a dispensation for an oral fluoroquinolone (ciprofloxacin, levofloxacin, moxifloxacin, and norfloxacin) between January 1, 2008 and December 31, 2022.
- Overall utilization analysis: Crude dispensation rates were estimated yearly and expressed per 1,000 population. Rates were calculated by age groups and sex.
- Impact assessment analysis: We used interrupted time-series analyses to assess the impact of the regulatory actions by estimating the change in the rate of fluoroquinolone dispensations and the percentage of antibiotic dispensations that are fluoroquinolones for 3 specific conditions.
What did the study find?
- Fluoroquinolone utilization:
- Overall dispensation rates of the 4 oral fluoroquinolones decreased by approximately 50% across provinces, sexes, and age groups between 2008 and 2022 (from 107 to 45 dispensations per 1,000 population).
- Fluoroquinolone use decreased for the treatment of adults with acute bacterial sinusitis, acute exacerbations of COPD (≥ 66 years only), and uncomplicated UTIs (females only).
- Interprovincial variation in the use of fluoroquinolones was noted.
- Impact assessment:
- The reduction in the rates of fluoroquinolone dispensations was 50% from January 1, 2017 to February 29, 2020 (segment 2) and 62% from March 1, 2020 to December 31, 2022 (segment 3) relative to segment 1 (January 1, 2008 to December 31, 2016; before introduction of the risk minimization measures).
- Similarly, reductions in the percentages of antibiotic dispensations for fluoroquinolones were observed for the 3 selected conditions: acute bacterial sinusitis, acute exacerbations of COPD (≥ 66 years only), and uncomplicated UTIs (females only).
- There were variations across provinces in the magnitude of the reductions in the rates of fluoroquinolone dispensations and the percentage of antibiotic dispensations that were fluoroquinolones.
Implications
- Our findings from this multi-province study suggest that the Health Canada regulatory actions could have affected the prescribing of fluoroquinolones. However, unmeasured factors, including health care system and patient characteristics, and differences in data characteristics across provinces, including data coding practices, may also have had an impact on prescribing.
Key messages
- Use of oral fluoroquinolones in the outpatient setting declined in all provinces between 2008 and 2022.
- The 2017 Health Canada regulatory actions were followed by reductions in fluoroquinolone dispensation rates and percentages of antibiotic dispensations that are fluoroquinolones for the 3 selected indications, although a decreasing trend was observed prior to the regulatory actions./li>
Manuscripts
Lix LM, Dahl M, St-Jean A, Golandouz HM, Ling V, Janzen D, Ronksley PE, Scory TD, Dutton DJ, Manning D, Carney G, Perras C, Ernst P; for the Canadian Network for Observational Drug Effect Studies (CNODES) Investigators. Impact of risk mitigation measures on oral fluoroquinolone prescribing: a multi-site population-based Canadian cohort study. Arch Public Health. 2026 Mar 25. Epub ahead of print.