Flu diagnosis, vaccination curbs unnecessary antibiotic use
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Accurate influenza diagnosis and vaccination could curtail unnecessary antibiotic use and help reduce the global threat of antibiotic resistance, according to findings in Clinical Infectious Diseases.
“Direct evidence for the association of routine influenza vaccination and antibiotic prescribing, particularly in the real-world setting, is insufficient and predominantly from ecological studies or small studies of focused conditions (eg, acute otitis media) or specific age groups,” Manish M. Patel, MD, team lead of the influenza prevention and control team at the CDC’s National Center for Immunization and Respiratory Diseases, told Healio.
Patel and colleagues enrolled outpatients aged 6 months and older with acute respiratory illness (ARI) from more than 50 U.S. clinics over five winters from 2013 to 2018 and tested for influenza with real-time PCR. The researchers also gathered information about antibiotic prescriptions and diagnosis codes for ARI syndromes and estimated vaccine effectiveness (VE) by comparing vaccination odds among influenza-positive cases to test-negative controls. They then estimated ARI visits and antibiotic prescriptions that were prevented by influenza vaccination using estimates of VE, coverage and prevalence of antibiotic prescriptions and influenza.
According to the study, of 37,487 outpatients with ARI, 9,659 (26%) were positive for influenza; 36% of patients with ARI and 26% of patients with influenza were prescribed antibiotics. The top three most common ARI syndromes were viral upper respiratory tract infection (47%), pharyngitis (18%) and allergy or asthma (11%). ARI syndromes classified as “other” accounted for 42% of cases. More than three-quarters of patients who tested positive for influenza (77%) did not receive an ICD-CM diagnostic code for influenza.
Overall, VE against influenza-associated ARI was 35% (95% CI, 32%-39%). Study results showed that vaccination averted 5.6% of all ARI syndromes, ranging from 2.8% (sinusitis) to 11% (clinical influenza). Additionally, influenza vaccination prevented one in 25 antibiotic prescriptions among outpatients with ARI during influenza seasons (3.8%; 95% CI, 3.6%-4.1%).
“Influenza vaccination and accurate influenza diagnosis curbs potentially unnecessary antibiotic use and reduces the global threat of antibiotic resistance,” Patel concluded.
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