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Few outpatients receive antiviral prescriptions for influenza
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Only 7.5% of patients presenting to ambulatory care for acute respiratory illness received an antiviral prescription, CDC researchers have found. Among the patients with confirmed influenza, only 15% received an antiviral prescription.
“Influenza vaccination is the primary strategy to prevent influenza,” the researchers wrote in Clinical Infectious Diseases. “However, antiviral treatment plays an important role in decreasing influenza-related morbidity and mortality. Our results suggest that during 2012-2013, antiviral medications were underprescribed and antibiotics may have been inappropriately prescribed to a large proportion of outpatients with influenza.”
Using data from five sites in the US Influenza Vaccine Effectiveness Network Study, the researchers determined the number of patients aged at least 6 months who presented for outpatient care with acute respiratory illness. They evaluated how many patients were prescribed antiviral medications and how many had confirmed influenza by PCR. They also analyzed antibiotic prescriptions at four sites with that data.
There were 6,766 patients with acute respiratory illness and 509 (7.5%) received an antiviral prescription. Among the patients, 2,366 had confirmed influenza and only 355 (15%) had received an antiviral prescription. The cohort also included 1,021 patients at high risk for influenza-associated complications due to age or chronic medical condition. Among those, 195 (19%) received an antiviral prescription.
In a subset of 1,825 patients who had confirmed influenza and data on antibiotic prescriptions, 540 (30%) were prescribed either amoxicillin-clavulanate, amoxicillin or azithromycin. Only 297 of the 1,825 patients (16%) were prescribed antiviral medications.
“Few ambulatory care providers appeared to follow current antiviral guidance recommending antiviral treatment for persons at high risk for influenza-associated complications,” the researchers wrote. “Additional efforts are needed to understand the barriers to the use of antiviral treatment in ambulatory care settings and to better communicate the benefits of prompt antiviral therapy.”
Disclosure: Some researchers report relationships with BioCryst Pharmaceuticals, Inviragen, Medimmune, Merck, Novartis, Pfizer, Roche and Sanofi.
Perspective
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Timothy Jones, MD
The benefits of early use of antiviral agents for influenza, particularly in high-risk patients, are widely accepted, and numerous national guidelines (including those of IDSA) recommend their use. This describes a large study of antimicrobial use in patients with and without laboratory-documented influenza. Disturbingly (if not surprisingly), not only were antivirals used too seldom, but antibiotics appear to have been markedly over-used.
In this study of more than 6,700 patients with acute respiratory infection (ARI), one-third had laboratory-confirmed influenza. Only 15% of those with influenza received antivirals, whereas twice as many were prescribed antibiotics. Even among ARI patients at high risk for influenza complications, fewer than one in five were prescribed antivirals.
Clearly, current national efforts to improve response to influenza and promote appropriate antibiotic use have yet to achieve their desired effects. It is admirable that both of these issues are receiving the widespread attention that they are, but the persistence of the problems clearly indicates that new approaches must be developed. In the meantime, it remains incumbent on infectious disease specialists to capitalize on every available opportunity to educate and encourage colleagues (as well as our patients) regarding appropriate use of antimicrobials for suspected influenza.
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