Clinicians under-prescribing flu antiviral drugs, maybe overprescribing antibiotics

Dr Havers

Clinicians are still more likely to prescribe antibiotics rather than antiviral medications to outpatients with flu, including to high-risk patients who would benefit from early empiric antiviral treatment, according to a study published in Clinical Infectious Diseases.

Using data collected during the 2012-13 flu season from 5 ambulatory care sites in the U.S Flu Vaccine Effectiveness Network, Fiona Havers, MD, MHS, Influenza Division, Centers for Disease Control and Prevention (CDC), and colleagues analyzed antiviral prescriptions among outpatients with acute respiratory illness (ARI) and antibiotic prescriptions among patients with flu.

The study shows that during the 2012 to 2013 flu season, flu antiviral medications (ie, oseltamivir and zanamivir) were prescribed infrequently among outpatients with flu for whom antiviral therapy would be most beneficial. 2,366 (35%) of the 6,766 enrolled ARI patients had PCR-confirmed flu, but only 355 (15%) of those with confirmed flu had received an antiviral prescription.

“Prompt influenza antiviral treatment, within 2 days of illness onset, may reduce the probability of secondary complications among hospitalized and ambulatory care patients with influenza,” Dr Havers said.

Overall, only 19% of patients at high risk for flu-associated complications and presenting to care within 2 days of symptom onset received antiviral treatment, regardless of laboratory testing, according to the study.

In contrast, prescriptions for antibiotics were provided more frequently and may have been over-used among clinicians caring for outpatients with lab-confirmed flu.

“Antiviral drugs are different from antibiotics,” Dr Havers explained. “Antiviral drugs fight influenza viruses in your body. Antibiotics fight against bacterial infections.”

Thirty percent of outpatients with PCR [polymerase chain reaction]-confirmed flu received 1 of the 3 antibiotics examined in this study.

“Antibiotics are not recommended for treatment of viral infections because they do not benefit patients and can put them at harm for allergic reactions, antibiotic-resistant infections, and deadly diarrhea caused by the bacteria Clostridium difficile,” Dr Havers said.

CDC recommends early antiviral treatment for people with suspected flu illness who are at higher risk for flu complications or who are severely ill. This includes hospitalized patients with suspected or confirmed influenza, those with severe or progressive illness, and outpatients who are at high risk for flu complications (for example, young children, people aged 65 years and older, pregnant women, and persons with certain underlying chronic medical conditions).

“Managed care organizations that have outpatients should work to educate clinicians about the benefits of appropriately prescribed antiviral medications and the dangers of inappropriate antibiotic overuse,” she said. “In addition, hospital decision-makers should encourage prompt treatment with antiviral medications for those hospitalized with suspected influenza.”

Additional efforts are needed to understand the barriers in the use of antiviral treatment in ambulatory care settings and to better communicate the benefits of prompt antiviral therapy, especially for those at high risk for flu-associated complications, according to Dr Havers. 

“Educating clinicians on appropriate antibiotic and antiviral use is essential to improving healthcare quality,” she said.

Little was known about antiviral medication use in recent years, especially in ambulatory care settings, according to Dr Havers. “In addition, the use of antibiotics for ARIs is often inappropriate and may contribute to antibiotic resistance. However, few studies have compared the use of both antiviral and antibiotic drugs in outpatients presenting with influenza-associated acute respiratory infections.”