Journal of General Internal Medicine

, Volume 24, Issue 4, pp 504–510 | Cite as

Antiviral and Antibiotic Prescribing for Influenza in Primary Care

  • Jeffrey A. LinderEmail author
  • Harry Reyes Nieva
  • William A. Blumentals
Original Article



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


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.


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.


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).


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.


influenza, human antiviral agents antibacterial agents drug utilization 



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.


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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Jeffrey A. Linder
    • 1
    • 2
    Email author
  • Harry Reyes Nieva
    • 1
  • William A. Blumentals
    • 3
  1. 1.Division of General Medicine and Primary CareBrigham and Women’s HospitalBostonUSA
  2. 2.Harvard Medical School (JAL)BostonUSA
  3. 3.Roche Pharmaceuticals (WAB)NutleyUSA

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