Skip to main content

Advertisement

SpringerLink
Log in

Antiviral and Antibiotic Prescribing for Influenza in Primary Care

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND

Anti-influenza antiviral medications reduce influenza-related morbidity, but may often be used inappropriately.

OBJECTIVE

To measure the rate of antiviral and antibiotic prescribing, the appropriateness of antiviral prescribing, and evaluate independent predictors of antiviral and antibiotic prescribing for influenza in primary care.

DESIGN AND PATIENTS

Retrospective analysis of 958 visits of clinician-diagnosed influenza in 21 primary care clinics in eastern Massachusetts from 1999 to 2007. We considered antiviral prescribing appropriate if patients had symptoms for 2 or fewer days, had fever, and any 2 of headache, sore throat, cough, or myalgias.

MEASUREMEMTS AND MAIN RESULTS

Clinicians prescribed antivirals in 557 (58%) visits and antibiotics in 104 visits (11%). Of antiviral prescriptions, 38% were not appropriate, most commonly because of symptoms for more than 2 days (24% of antiviral prescriptions). In multivariate modeling, selected independent predictors of antiviral prescribing were symptom duration of 2 or fewer days (odds ratio [OR], 12.4; 95% confidence interval [CI], 8.3 to 18.6), year (OR, 1.4 for each successive influenza season; 95% CI, 1.3 to 1.7), patient age (OR, 1.3 per decade; 95% CI, 1.2 to 1.5), and, compared to having no influenza testing, having a negative influenza test (OR, 5.5; 95% CI, 3.4 to 9.1) or a positive influenza test (OR, 11.4; 95% CI, 6.7 to 19.3). Independent predictors of antibiotic prescribing included otoscopic abnormalities (OR, 3.3; 95% CI, 1.8 to 6.0), abnormal lung examination (OR, 4.0; 95% CI, 2.1 to 6.2), and having a chest x-ray performed (OR, 2.2; 95% CI, 1.3 to 3.8).

CONCLUSIONS

Primary care clinicians are much more likely to prescribe antivirals to patients with symptoms for 2 or fewer days, but also commonly prescribe antivirals inappropriately.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. MMWR. 2007;56(RR-6):1–54.

    Google Scholar 

  2. Glezen WP. Prevention and treatment of seasonal influenza. New Engl J Med. 2008;359(24):2579–2585.

    Article  PubMed  CAS  Google Scholar 

  3. Lalezari J, Campion K, Keene O, Silagy C. Zanamivir for the treatment of influenza A and B infection in high-risk patients: a pooled analysis of randomized controlled trials. Arch Intern Med. 2001;161(2):212–217.

    Article  PubMed  CAS  Google Scholar 

  4. Libow LS, Neufeld RR, Olson E, Breuer B, Starer P. Sequential outbreak of influenza A and B in a nursing home: efficacy of vaccine and amantadine. J Am Geriatr Soc. 1996;44(10):1153–1157.

    PubMed  CAS  Google Scholar 

  5. Bowles SK, Lee W, Simor AE, et al. Use of oseltamivir during influenza outbreaks in Ontario nursing homes, 1999–2000. J Am Geriatr Soc. 2002;50(4):608–616.

    Article  PubMed  Google Scholar 

  6. Rothberg MB, Bellantonio S, Rose DN. Management of influenza in adults older than 65 years of age: cost-effectiveness of rapid testing and antiviral therapy. Ann Intern Med. 2003;139:321–329.

    PubMed  Google Scholar 

  7. Rothberg MB, He S, Rose DN. Management of influenza symptoms in healthy adults: cost-effectiveness of rapid testing and antiviral therapy. J Gen Intern Med. 2003;18:808–815.

    Article  PubMed  Google Scholar 

  8. Barr CE, Schulman K, Iacuzio D, Bradley JS. Effect of oseltamivir on the risk of pneumonia and use of health care services in children with clinically diagnosed influenza. Curr Med Res Opin. 2007;23(3):523–531.

    Article  PubMed  CAS  Google Scholar 

  9. McGeer A, Green KA, Plevneshi A, et al. Antiviral therapy and outcomes of influenza requiring hospitalization in Ontario, Canada. Clin Infect Dis. 2007;45(12):1568–1575.

    Article  PubMed  Google Scholar 

  10. Linder JA, Bates DW, Platt R. Antivirals and antibiotics for influenza in the United States, 1995–2002. Pharmacoepidemiol Drug Saf. 2005;14(8):531–536.

    Article  PubMed  Google Scholar 

  11. Linder JA, Chan JC, Bates DW. Appropriateness of antiviral prescribing for influenza in primary care: a retrospective analysis. J Clin Pharm Ther. 2006;31(3):245–252.

    Article  PubMed  CAS  Google Scholar 

  12. Cole JA, Loughlin JE, Ajene AN, Rosenberg DM, Cook SE, Walker AM. The effect of zanamivir treatment on influenza complications: a retrospective cohort study. Clin Ther. 2002;24(11):1824–1839.

    Article  PubMed  CAS  Google Scholar 

  13. Gums JG, Pelletier EM, Blumentals WA. Oseltamivir and influenza-related complications, hospitalization and healthcare expenditure in healthy adults and children. Expert Opin Pharmacother. 2008;9(2):151–161.

    Article  PubMed  CAS  Google Scholar 

  14. Blumentals WA, Schulman KL. Impact of oseltamivir on the incidence of secondary complications of influenza in adolescent and adult patients: results from a retrospective population-based study. Curr Med Res Opin. 2007;23(12:)2961–2970.

    Article  PubMed  CAS  Google Scholar 

  15. Cox F, Khan ZM, Schweinle JE, Okamoto L, McLaughlin T. Cost associated with the treatment of influenza in a managed care setting. MedGenMed. 2000;2(4):E34.

    PubMed  CAS  Google Scholar 

  16. Murphy SN, Chueh HC. A security architecture for query tools used to access large biomedical databases. AMIA Annu Symp Proc. 2002:552–556.

  17. Two neuraminidase inhibitors for treatment of influenza. Med Lett Drugs Ther. 1999;41(1063):91–93.

    Google Scholar 

  18. Rapid diagnostic tests for influenza. Med Lett Drugs Ther. 1999;41(1068):121–122.

  19. Linder JA, Bates DW, Williams DH, Connolly MA, Middleton B. Acute infections in primary care: accuracy of electronic diagnoses and electronic antibiotic prescribing. J Am Med Inform Assoc. 2006;13(1):61–66.

    Article  PubMed  Google Scholar 

  20. Centers for Disease Control and Prevention. High levels of adamantane resistance among influenza A (H3N2) viruses and interim guidelines for use of antiviral agents — United States, 2005–2006 influenza season. MMWR. 2006;55(2):44–46.

    Google Scholar 

  21. The MIST (Management of Influenza in the Southern Hemisphere Trialists) Study Group. Randomised trial of efficacy and safety of inhaled zanamivir in treatment of influenza A and B virus infections. Lancet. 1998;352(9144):1877–1881.

    Article  Google Scholar 

  22. Monto AS, Fleming DM, Henry D, et al. Efficacy and safety of the neuraminidase inhibitor zanamivir in the treatment of influenza A and B virus infections. J Infect Dis. 1999;180(2):254–261.

    Article  PubMed  CAS  Google Scholar 

  23. Monto AS, Gravenstein S, Elliott M, Colopy M, Schweinle J. Clinical signs and symptoms predicting influenza infection. Arch Intern Med. 2000;160(21):3243–3247.

    Article  PubMed  CAS  Google Scholar 

  24. Zambon M, Hays J, Webster A, Newman R, Keene O. Diagnosis of influenza in the community: relationship of clinical diagnosis to confirmed virological, serologic, or molecular detection of influenza. Arch Intern Med. 2001;161(17):2116–2122.

    Article  PubMed  CAS  Google Scholar 

  25. Centers for Disease Control and Prevention. Flu Activity & Surveillance. Available at: http://www.cdc.gov/flu/weekly/fluactivity.htm. Accessed January 12, 2009.

  26. Falsey AR, Murata Y, Walsh EE. Impact of rapid diagnosis on management of adults hospitalized with influenza. Arch Intern Med. 2007;167(4):354–360.

    Article  PubMed  Google Scholar 

  27. Linder JA. Improving care for acute respiratory infections: better systems, not better microbiology. Clin Infect Dis. 2007;45(9):1189–1191.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by Roche.

Prior Presentations

Previously presented in part at the Society of General Internal Medicine, 31st Annual Meeting, Pittsburgh, Pennsylvania, April 11, 2008 and at the American Academy of Family Practice Scientific Assembly, San Diego, California, September 18–20, 2008.

Conflict of Interest Statement

Dr. Linder is supported by a Career Development Award (K08 HS014563) from the Agency for Healthcare Research and Quality and has a research grant from Pfizer to study ambulatory adverse drug events. Dr. Blumentals is an employee of Roche.

Author information

Authors and Affiliations

  1. Division of General Medicine and Primary Care, Brigham and Women’s Hospital, 1620 Tremont Street, BC-3-2X, Boston, MA, 02120, USA

    Jeffrey A. Linder MD, MPH & Harry Reyes Nieva

  2. Harvard Medical School (JAL), Boston, MA, USA

    Jeffrey A. Linder MD, MPH

  3. Roche Pharmaceuticals (WAB), Nutley, NJ, USA

    William A. Blumentals PhD

Authors
  1. Jeffrey A. Linder MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Harry Reyes Nieva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William A. Blumentals PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeffrey A. Linder MD, MPH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Linder, J.A., Reyes Nieva, H. & Blumentals, W.A. Antiviral and Antibiotic Prescribing for Influenza in Primary Care. J GEN INTERN MED 24, 504–510 (2009). https://doi.org/10.1007/s11606-009-0933-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-009-0933-9

KEY WORDS

Search

Navigation