Antiviral and Antibiotic Prescribing for Influenza in Primary Care

• Published in: Journal of general internal medicine : JGIM 2009-04, Vol.24 (4), p.504-510
• Main Authors: Linder, Jeffrey A., Reyes Nieva, Harry, Blumentals, William A.
• Format: Article
• Language: English
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Antiviral Agents - therapeutic use; Antiviral drugs; Biological and medical sciences; Child; Female; General aspects; Humans; Influenza; Influenza, Human - drug therapy; Internal Medicine; Male; Massachusetts; Medical sciences; Medicine; Medicine & Public Health; Original; Original Article; Pharmacology. Drug treatments; Prescriptions; Primary care; Primary Health Care; Retrospective Studies
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-009-0933-9

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.