title: [Issues about the implementation of the guideline <<The management of influenza-like syndrome>>].
abstract: OBJECTIVE
  to assess the feasibility in clinical practice of the recommendations included in the guideline <<The management of influenza-like syndrome>>.
  
  
  METHODS
  a prevalence study on clinical behaviour concerning drug prescription and hospitalization. Behaviours will be reassessed after a short follow-up (5 days).
  
  
  METHODS
  general practitioners and paediatricians have been enrolled, who will refer about the clinical behaviours adopted toward a series of consecutively enrolled patients with influenza-like syndrome.
  
  
  METHODS
  compliance to the recommendations has been assessed, through the proportion of patients prescribed antibiotics, and anti-inflammatory/antipyretic and antiviral drugs. The use of diagnostic tests and the number of hospitalizations have been also assessed.
  
  
  RESULTS
  clinicians, according to the recommendations included in the guideline, rarely use antiviral drugs and quick diagnostic tests, and mainly prescribe paracetamol for the treatment of pain and fever. On the other hand, they still prescribe antibiotics to more than 30% of patients on the basis of reasons not discussed in the guideline, and sometimes sustainable, even if they are not recommended. The lack of effectiveness of the recommendation concerning the use of antibiotics in guiding clinicians' behaviour, emerges particularly in two specific scenarios: the presence of comorbidities in elderly patients and the persistency of fever in children.
  
  
  CONCLUSIONS
  the use of antibiotics in course of influenza-like syndrome is not necessarily inappropriate, and should be further investigated. Some specific characteristics shown by patients are relevant for frequency and severity, and could be interpreted as effect modifiers. Therefore recommendations should take into consideration such subgroups.
authors.affiliation: Dipartimento di prevenzione ASL 6 di Livorno, Borgo San Jacopo 59, 57127 Livorno. s.demasi@usl6.toscana.it
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Masi
authors.forename: Luciano
authors.initials: L
authors.lastname: Sagliocca
authors.forename: Franca
authors.initials: F
authors.lastname: D'Angelo
authors.forename: Cristina
authors.initials: C
authors.lastname: Morciano
authors.forename: Paola
authors.initials: P
authors.lastname: Laricchiuta
authors.forename: Eleonora
authors.initials: E
authors.lastname: Lacorte
authors.forename: Alfonso
authors.initials: A
authors.lastname: Mele
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D058633:Antipyretics / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000592:standards*; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D016330:Frail Elderly; D058005:General Practitioners / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D007251:Influenza, Human / Q000517:prevention & control / Q000628:therapy*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D058633:Antipyretics; D000998:Antiviral Agents; D007252:Influenza Vaccines