Oral Fluoroquinolone Prescribing to Children in the United States From 2006 to 2015

Background: Fluoroquinolone (FQ) prescription rates have increased over the last 10 years despite recent warnings of serious adverse effects such as peripheral neuropathy and tendinopathy. Currently, there are no published data on the extent or appropriateness of FQ prescribing in children. Methods: Drug prescription data from the PharMetrics Plus health claims database (United States) were analyzed to examine dispensing of ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin, or gemifloxacin to children from 2006 to 2015. Based on American Academy of Pediatrics recommendations, an algorithm was created to quantify inappropriate FQ prescriptions, which was further stratified by age and FQ type. Results: Among a cohort of 2,754,431 children, 372,357 prescriptions for an oral FQ were dispensed between 2006 and 2015. An increase was observed in FQ prescriptions from 2006 to 2013, with numbers coming down in 2014 and 2015. Ciprofloxacin was the most frequently prescribed FQ (334,268 prescriptions) followed by levofloxacin (19,386), moxifloxacin (18,434) and combined ofloxacin/gemifloxacin prescriptions (369). Of the FQ prescriptions in children, 48% were prescribed to those 10 years of age or younger, and 22% were deemed inappropriate. Conclusions: Our study suggests an increase in the prescribing of FQs, mostly ciprofloxacin, over a 10-year period, although numbers have decreased slightly in 2014 and 2015. At least 1 in 5 prescriptions were deemed unnecessary. In light of recent FQ safety warnings and lack of longterm safety data with FQ use in children and potential risk of increasing antibiotic resistance, clinicians are advised to refrain from using FQs for uncomplicated community-acquired infections.