After Pick, Levothyrox, or Androcur, will fluoroquinolones be added to the list of health scandals that regularly shake our country? These broad-spectrum antibiotics can cause potentially serious side effects: tendon ruptures, heart rhythm disorders, aneurysms and aortic dissection, neuropathies, neuropsychiatric conditions… Patients who have been victims of them announced at the beginning of the week their intention to file a complaint for “involuntary injuries” and for “aggravated deception”. They believe that these drugs should never have been prescribed to them.
And for good reason. In 2019, because of these risks, the European Medicines Agency (EMA) strongly restricted the infections in which these molecules can be administered. But the information is struggling to pass: a study by the EMA showed that in France, 66% of prescriptions did not comply with these new rules.
“The National Medicines Safety Agency sent letters to doctors, and they thought that was enough to be heard,” fumes Philippe Coville, an engineer who suffered serious side effects after being prescribed one of these antibiotics for a simple urinary tract infection – a condition for which it was no longer recommended to use them. He has since created an association of victims.
Impoverishment of public action
“Information is not training. This is not enough to change thirty years of well-established prescription habits. This is the demonstration that we have just had, once again, with this crisis”, laments Professor Mathieu Molimard, communication manager of the French Society of Pharmacology and Therapeutics (SFPT). The subject is nothing new. In 2013, a report handed over to the Minister of Health at the time, Marisol Touraine, already pointed out the lack of initial and continuous training of doctors in the proper use of the drug. The difficulty, too, of getting them up-to-date information or health alerts. “Since then, nothing has changed. On the contrary, we are facing an impoverishment of public action in this area”, regrets one of its authors, Bernard Bégaud, professor emeritus of pharmacoepidemiology.
Professor Molimard, with the National College of Medical Pharmacology, had imagined a continuing education platform for doctors – an idea that had been taken up in the recommendations of this report. “It was a completely independent tool, managed by professionals free of any conflict of interest, in conjunction with learned societies. It could have provided doctors with continuing education modules, but also alerts and information, formulated in a way adapted to their needs”, he explains. With Professor Bégaud, they then toured the health and political authorities – ministry, health insurance, Elysée advisers – to try to convince of the usefulness of such a device. In vain: “Everyone told us it was great, but we never got a penny for this project”.
A faster decrease in the Nordic countries
Since 2019, the prescription of fluoroquinoles has certainly decreased in France. But very insufficiently. “In the Nordic countries, in Austria or in Germany, the consumption of these molecules has decreased much faster than in France”, assures Philippe Coville, who immersed himself in the statistics of the European Agency for Medicines and Health. ECDC, the European Center for Disease Prevention and Control. Since the alert launched by the patients, the ANSM claims to have taken additional measures, including updating the prescription assistance software for pharmacies and doctors. Not enough to convince Philippe Coville: “I realized that these tools were in fact very rare”, he regrets. Other actions are however in preparation, “with in particular the sending in the coming weeks of a mailing intended for all health professionals who can prescribe these antibiotics”, indicates the ANSM to the Express.
For Professor Molimard, it would be necessary to go much further. If there is no question of prohibiting these molecules, which can prove to be valuable as a second resort or in certain very specific pathologies, the pharmacologist pleads for the prescription of fluoroquinolones to be accompanied by a letter from the doctor co-signed by the patient, explaining the reasons for choosing this medicine. On this condition only, the pharmacist would be authorized to dispense them. “The ANSM tells us that it does not have the legal means for this type of measure. But in this case, that the public authorities take the necessary texts”, pleads Mathieu Molimard. Will this new case finally be an opportunity to implement an effective drug information system? “Fluoroquinolones are only one example among many of the misuse of the drug in France”, underlines Bernard Bégaud. There is therefore an urgency, at the risk otherwise of continuing to see business multiply.