{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T19:27:45Z","timestamp":1771529265998,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T00:00:00Z","timestamp":1675382400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To determine possible changes in prescribing of fluoroquinolones in relation to the European Medicines Agency's (EMA) recommendation in October 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a nationwide time\u2010series study on outpatient use of fluoroquinolones during January 2016\u2013June 2021 in Estonia. Joinpoint regression was used to identify change points over time. Several subgroup analyses by prescriber specialty, indication group, risk factors for tendon injury, aortic aneurysm\/dissection or heart valve regurgitation\/incompetence and the prescribing of other antibiotics were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the study period 236\u2009989 prescriptions of fluoroquinolones were dispensed to 142\u2009659 persons. The number of episodes per month declined from 3780 (2.9\/1000 inhabitants) to 2570 (1.9\/1000 inhabitants). We identified three change points with four different trend segments: from January 2016 to November 2018 monthly percent change (MPC) \u22120.4%, from November 2018 to June 2019 MPC \u22122.5%, from June 2019 to July 2020 MPC 1.7% and from July 2020 to June 2021 MPC \u22123.3%. Prescribing for indications which were removed or restricted by EMA's recommendation comprised a small proportion of all fluoroquinolone episodes \u22122.8% and 6.3%, respectively. The risk factors for tendon injury and for cardiac disorders (aortic aneurysm\/dissection or heart valve regurgitation\/incompetence) were present in 46.4% and 57.8% episodes of fluoroquinolone users, respectively. No changes in the trend of prescribing to users with risk factors was detected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The EMA's recommendation may have contributed to the greater decline in the use of fluoroquinolones. However, there is still a high proportion of users with predisposing factors for tendon injury and serious cardiac disorders.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.5593","type":"journal-article","created":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T02:54:47Z","timestamp":1674528887000},"page":"643-650","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Outpatient fluoroquinolone use in relation to European Medicines Agency's recommendation: An Estonian nationwide drug utilization study"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8728-651X","authenticated-orcid":false,"given":"Katrin","family":"Kurvits","sequence":"first","affiliation":[{"name":"Department of Post\u2010authorisation Safety State Agency of Medicines  Tartu Estonia"},{"name":"Institute of Family Medicine and Public Health University of Tartu  Tartu Estonia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maia","family":"Uusk\u00fcla","sequence":"additional","affiliation":[{"name":"Department of Post\u2010authorisation Safety State Agency of Medicines  Tartu Estonia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helve","family":"Vestman","sequence":"additional","affiliation":[{"name":"Department of Post\u2010authorisation Safety State Agency of Medicines  Tartu Estonia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ott","family":"Laius","sequence":"additional","affiliation":[{"name":"Department of Post\u2010authorisation Safety State Agency of Medicines  Tartu Estonia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,2,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.jac.a020889"},{"key":"e_1_2_11_3_1","first-page":"455","article-title":"Quinolones: a comprehensive review","volume":"65","author":"Oliphant CM","year":"2002","journal-title":"Am Fam Physician"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199501193320319"},{"key":"e_1_2_11_5_1","unstructured":"European Medicines Agency.Fluoroquinolone and quinolone antibiotics: PRAC recommends restrictions on use. New restrictions follow review of disabling and potentially long\u2010lasting side effects. October 5 2018. Accessed March 15 2022.https:\/\/www.ema.europa.eu\/en\/documents\/referral\/quinolone\u2010fluoroquinolone\u2010article\u201031\u2010referral\u2010prac\u2010recommends\u2010restrictions\u2010use_en.pdf"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2012.05.027"},{"key":"e_1_2_11_7_1","unstructured":"European Medicines Agency.Quinolone and fluoroquinolone Article\u201031 referral. Amendments to relevant sections of the product information."},{"key":"e_1_2_11_8_1","unstructured":"Ravimiamet.Fluorokinoloonide r\u00fchma antibiootikumide uued kasutamispiirangud. October 5 2018. Accessed March 15 2022.https:\/\/www.ravimiamet.ee\/uudised\/fluorokinoloonide\u2010ruhma\u2010antibiootikumide\u2010uued\u2010kasutamispiirangud"},{"key":"e_1_2_11_9_1","unstructured":"Ravimiregister.Ohutusalane teabekiri. October 29 2020. Accessed March 15 2022.https:\/\/www.ravimiregister.ee\/Data\/aRMM\/12271\/6734f69d\u201034a6\u20104441\u201095a1\u2010f4a2f37d15de\/Ohutusalane%20teabekiri_S%C3%BCsteemsed%20ja%20inhaleeritavad%20fluorokinoloonid%20\u2010%20\u2009s%C3%BCdameklapi%20regurgitatsiooni%20tekke%20risk.pdf"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k678"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.5389"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00151-21"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab538"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.36662"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2021.1154"},{"key":"e_1_2_11_16_1","unstructured":"Eesti Haigekassa.2021. 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Scientific conclusions.2019."},{"key":"e_1_2_11_20_1","unstructured":"Statistical Research and Applications Branch NCI.Joinpoint Regression Program Version 4.7.0.0https:\/\/surveillance.cancer.gov\/joinpoint\/"},{"key":"e_1_2_11_21_1","volume-title":"RStudio: Integrated Development for R","author":"RStudio Team","year":"2021"},{"key":"e_1_2_11_22_1","unstructured":"European Centre for Disease Prevention and Control.Antimicrobial Consumption in the EU\/EEA (ESAC\u2010Net) \u2010 Annual Epidemiological Report for 2020. 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