Antivirals Used Inappropriately in 38% of Influenza Cases: Presented at AAFP

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Title: Antivirals Used Inappropriately in 38% of Influenza Cases: Presented at AAFP
URL: http://www.pslgroup.com/dg/22D3A6.htm
Doctor's Guide
September 22, 2008

By Martha Kerr, BSN

SAN DIEGO -- September 22, 2008 -- Antiviral medications are prescribed inappropriately for influenza symptoms in 38% of cases. This is due to both over- and underprescribing, said researchers from Harvard Medical School here at the American Academy of Family Physicians (AAFP) 2008 Scientific Assembly.

"Some patients with flu symptoms are getting antivirals when they shouldn't and there are a significant number who do not get them when they should," said lead investigator Jeffrey A. Linder, MD, MPH, Brigham and Woman's Hospital and Harvard Medical School, Boston, Massachusetts, at a poster presentation on September 19.

Dr. Linder and colleagues performed a retrospective analysis of 958 office visits to primary care clinics during influenza seasons between October 1999 and May 2007. The researchers recorded the number of prescriptions written or not written for antiviral medication and whether the medication was indicated or not in each case.

Clinicians prescribed 1 of 4 approved antiviral drugs in 557 (58%) visits. They prescribed antibiotics in 104 visits (11%).

Symptom duration prior to the office visit was shorter for patients who received antivirals than for those who did not, with a median of 2 days versus 3 days, respectively (P < .0001). Median duration of symptoms prior to receiving an antibiotic was 3 days or longer (P = .01)

The leading predictor of antiviral prescribing was symptom duration of 2 or fewer days, with an odds ratio (OR) of 12.24 compared with more than 2 days.

Other predictors of antiviral prescribing were:

· influenza season (OR, 1.44, compared with other times of the year)

· patient age (OR, 1.31 for each increasing decade)

· Latino race and ethnicity (OR, 0.45 compared with Caucasians)

· no private insurance (OR, 1.83 compared with private insurance)

· an "ill appearance" (OR, 0.65)

· cough (OR, 0.54)

· otoscopic abnormality (OR, 0.48)

· having any blood test performed (OR, 0.49)

· having an influenza test done (OR, 7.80)

Independent predictors of antibiotic prescribing were:

· sore throat (OR, 0.62)

· headache (OR, 0.53)

· otoscopic abnormality (OR, 3.25)

· abnormal lung examination (OR, 3.95)

· having a chest x-ray performed (OR, 2.23)

"The key to appropriate prescribing is a symptom duration of less than 2 days," Dr. Linder said. "The mean duration of symptoms in this group was 5 to 7 days."

"Labelling on all the antivirals indicates treatment within 2 days of symptom onset or [these drugs are] worthless," he asserted. "The treatment algorithm is symptoms for less than 2 days, fever and any 2 of the following: headache, sore throat, cough, or myalgia."

"We found that 62% of patients met the criteria for antiviral treatment," Dr. Linder reported. "One-quarter of those got antivirals with a symptom duration of more than 2 days ... and another quarter didn't get them when they could have benefited. So it cuts both ways."

Funding for this study was provided by Roche Pharmaceuticals.

[Presentation title: Antiviral and Antibiotic Prescribing for Influenza in Primary Care.]

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