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July 23, 2014
Few High-Risk Patients Received Antivirals During Recent
Flu Season

Atlanta—Antivirals weren’t prescribed often enough to high-risk patients during the 2012-2013 influenza season, while antibiotics continued to be over-prescribed, according to a study led by researchers from the CDC.

The article, published recently in Clinical Infectious Diseases, calls for more education of outpatient clinicians in treating influenza.

In addition to recommending annual vaccination, the CDC also urges expeditious antiviral therapy for high-risk patients with influenza, including those who are hospitalized, who have severe influenza illness, or who are at higher risk for complications.

For the study, researchers focused on about 6,800 patients with acute respiratory illness who were seen at five outpatient care centers in the states of Washington, Wisconsin, Texas, Michigan, and Pennsylvania. Prescription records for two influenza antiviral drugs—oseltamivir and zanamivir—and three common antibiotics—amoxicillin-clavulanate, amoxicillin, and azithromycin—were reviewed.

The study found that when patients at high risk for influenza-association complications—i.e., under 2 years of age or 65 years or older or with one or more chronic medical conditions—saw their primary-care providers within 2 days of symptom onset, antiviral treatment was prescribed just 19% of the time. Even among patients with laboratory-confirmed influenza, only 16% received antiviral prescriptions, according to the report.

At the same time, 30% of those patients received one of the three antibiotics. The authors concede that some of the antibiotics may have been appropriate for bacterial infections secondary to influenza, but suggest that most were unnecessary and inappropriate for a viral illness, especially with the growing antibiotic resistance crisis.

“Our results suggest that during 2012-'13, antiviral medications were under-prescribed and antibiotics may have been inappropriately prescribed to a large proportion of outpatients with influenza,” the authors write. “Continuing education on appropriate antibiotic and antiviral use is essential to improve health care quality.”

Antiviral therapy for influenza reduces lower respiratory infections, hospitalizations, necessary antibiotic use, and stroke risk, according to an accompanying editorial from Michael G. Ison, MD, MS, of Northwestern University.

The study “demonstrates that we are clearly failing our patients by not providing antiviral therapy to patients with influenza consistent with current guidelines while exposing many of the patients to antibiotics from which they likely derive little benefit,” Ison writes.




U.S. Pharmacist Social Connect