Antiviral and Antibiotic Prescribing for Influenza in Primary Care
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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.
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).
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.
KEY WORDSinfluenza, human antiviral agents antibacterial agents drug utilization
This work was supported by Roche.
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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