Finding the right remedy
Getting the correct medicine to treat flu is still a challenge
Coming off the heels of one of the worst flu seasons on record — locally and nationally — is a federal report that shows doctors are still overprescribing antibiotics to treat the flu.
Simply put: That’s the wrong medicine — it doesn’t work on the virus.
Antivirals do work, but the report shows they’ve been under-prescibed.
One reason may be a low rate of confirming flu cases, said Fiona Havers, an infectious disease specialist with the Centers for Disease Control and Prevention, who led a study published Friday in JAMA Network Open.
“Most people who had influenza didn’t get a diagnosis of influenza,” she said. “During influenza season, clinicians should have a high index of suspicion for influenza and not treat them with antibiotics.”
During the 2013-14 and 2014-15 flu seasons, the study examined patient cases in clinics associated with five medical centers in the CDC’s flu vaccine effectiveness network, including the University of Pittsburgh. Patients coming in with acute respiratory infections (defined as trouble with normal breathing) were tested for flu for research purposes only. Clinic professionals did their own testing and diagnoses, and antibiotic or antiviral prescriptions were noted.
Of 14,987 patients, 41 percent were prescribed an antibiotic. Of those, 41 percent had diagnoses for which antibiotics are not indicated, the study reports.
That includes the flu, which was confirmed by testing in 3,381 patients (23 percent). Of that group, 3,306 patients had lab-confirmed flu but no condition calling for antibiotics. Nevertheless, 945(29 percent) were given antibiotic prescriptions; 656 (20 percent) got flu antiviral prescriptions, including 89 that got both.
Some people didn’t have just the flu. Flu was confirmed in 72 out of 375 (16 percent) pneumonia patients, in 18 percent of those with pharyngitis (sore throat), 11 percent with suppurative otitis media (ear infection with discharge), and 13 percent with sinusitis (sinus infection).
Antibiotics are considered appropriate for pneumonia, both viral and bacterial, and might be needed for sinus infection, sore throat and ear infection.
But flu and acute bronchitis are not on the list.
Dr. Havers noted that doctors often seemed to decide in favor of antibiotics in discretionary cases: “A huge proportion of [patients with] pharyngitis and sinusitis received antibiotics.”
She said more accurate rapid testing for the flu might make a difference. She said the study found that if patients were diagnosed with the flu, they were more likely to get appropriate therapy, with one of the recommended antiviral drugs, oseltamivir (Tamiflu), zanamivir (Relenza) or peramivir (Rapivab).
Antibiotics still take the lead, according to the study.
“A high proportion of negative strep throats still got antibiotics,” Dr. Havers said. “Many people who have a virus like influenza come in for a sore throat, test for strep, and even if it’s negative they get antibiotics. It’s the same with sinusitis and bronchitis. Most are caused by viruses.”
Even when antibiotics are called for, she said, sometimes the incorrect type is used.
For example, “Azithromycin in older people is very overprescribed. It’s prescribed even though they had no diagnosis that indicated an antibiotic would help.”
The CDC recommends antiviral drugs for the flu for anyone over 65, pregnant or at high risk for flu complications. The drugs work best if taken within the first two days of the illness.
Dr. Havers said she thinks the public is aware of the problem of overprescribing antibiotics. However, she said, “Based on this study there’s a lot of room for improvement.”