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Rapid flu tests reduce antibiotic prescriptions, additional visits
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Children who have confirmed influenza receive fewer antibiotics in the 10 days after diagnosis and were less likely to use further health care services compared with children who were diagnosed with influenza without a microbiologic confirmation.
Diego L. van Esso, MD, from the Catalan Institute of Health, and colleagues wrote that an estimated 20% to 30% of children in the United States and Europe are infected with influenza each season. In addition, an estimated 50% of children attending day care are affected by the illness. The researchers noted that making an influenza diagnosis in this age group can be difficult because of nonspecific signs and symptoms, including cough and fever.
Fifteen pediatricians practicing in four primary care centers took part in a prospective, longitudinal study that was conducted during the 2016-2017 influenza season. The researchers included any child aged younger than 5 years who had either a temperature of 38°C or higher or an axillary temperature between 37.2°C and 38°C with rhinorrhea, nasal congestion or cough within 72 hours of symptom onset.
Infants were separated into three groups: patients with a confirmed influenza test (group 1); patients who were diagnosed with influenza but did not have a confirmatory test (group 2); and patients who were diagnosed with either a viral infection of an unspecified site or a fever of a different origin (group 3).
van Esso and colleagues collected 189 nasopharyngeal swabs from children who met inclusion criteria, and the specimens were tested using two rapid influenza tests.
Of the children with suspected influenza, infection with influenza virus was confirmed for 49%, and 99% tested positive for influenza A virus. One child was infected with influenza B.
Ten days after influenza diagnosis, 4.4% of patients in group 1 who received a confirmed diagnosis through rapid testing were prescribed antibiotics compared with 7.2% of patients without microbiologic confirmation in group 2 and 9.7% in group 3. Additionally, children in group 1 were less likely to return to the physician within 10 days (0.19 additional visits per patient) compared with group 2 (0.48 additional visits per patient) and group 3 (0.81 additional visits per patient; P < .001).
van Esso and colleagues noted that the most important factors associated with incorrect influenza diagnosis is the prescription of antibiotics. Because symptoms of influenza infection can mimic bacterial infection symptoms, an accurate diagnosis can further assist in determining whether a patient should receive antimicrobial treatment.
“...The use of rapid influenza diagnostic tests with high sensitivity and specificity in primary care settings can provide important benefits in terms of clinical management of cases, reduction in antibiotic prescriptions, rate of further consultations and families’ trust in the diagnosis of influenza when confirmed using a point-of-care test.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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