title: Use of influenza antiviral agents by ambulatory care clinicians during the 2012-2013 influenza season.
abstract: BACKGROUND
  Early antiviral treatment (≤2 days since illness onset) of influenza reduces the probability of influenza-associated complications. Early empiric antiviral treatment is recommended for those with suspected influenza at higher risk for influenza complications regardless of their illness severity. We describe antiviral receipt among outpatients with acute respiratory illness (ARI) and antibiotic receipt among patients with influenza.
  
  
  METHODS
  We analyzed data from 5 sites in the US Influenza Vaccine Effectiveness Network Study during the 2012-2013 influenza season. Subjects were outpatients aged ≥6 months with ARI defined by cough of ≤7 days' duration; all were tested for influenza by polymerase chain reaction (PCR). Medical history and prescription information were collected by medical and pharmacy records. Four sites collected prescribing data on 3 common antibiotics (amoxicillin-clavulanate, amoxicillin, and azithromycin).
  
  
  RESULTS
  Of 6766 enrolled ARI patients, 509 (7.5%) received an antiviral prescription. Overall, 2366 (35%) had PCR-confirmed influenza; 355 (15%) of those received an antiviral prescription. Among 1021 ARI patients at high risk for influenza complications (eg, aged <2 years or ≥65 years or with ≥1 chronic medical condition) presenting to care ≤2 days from symptom onset, 195 (19%) were prescribed an antiviral medication. Among participants with PCR-confirmed influenza and antibiotic data, 540 of 1825 (30%) were prescribed 1 of 3 antibiotics; 297 of 1825 (16%) were prescribed antiviral medications.
  
  
  CONCLUSIONS
  Antiviral treatment was prescribed infrequently among outpatients with influenza for whom therapy would be most beneficial; in contrast, antibiotic prescribing was more frequent. Continued efforts to educate clinicians on appropriate antibiotic and antiviral use are essential to improve healthcare quality.
authors.affiliation: Epidemic Intelligence Service assigned to the Influenza Division.
authors.forename: Fiona
authors.initials: F
authors.lastname: Havers
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Swathi
authors.initials: S
authors.lastname: Thaker
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jessie R
authors.initials: JR
authors.lastname: Clippard
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Michael
authors.initials: M
authors.lastname: Jackson
authors.affiliation: Marshfield Clinic Research Foundation, Wisconsin.
authors.forename: Huong Q
authors.initials: HQ
authors.lastname: McLean
authors.affiliation: Baylor Scott & White Health, Texas A&M University Health Science Center College of Medicine, Temple, Texas.
authors.forename: Manjusha
authors.initials: M
authors.lastname: Gaglani
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
authors.forename: Arnold S
authors.initials: AS
authors.lastname: Monto
authors.affiliation: Department of Family Medicine, University of Pittsburgh, Pennsylvania.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Lisa
authors.initials: L
authors.lastname: Jackson
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
authors.forename: Josh G
authors.initials: JG
authors.lastname: Petrie
authors.affiliation: Department of Family Medicine, University of Pittsburgh, Pennsylvania.
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.affiliation: Department of Family Medicine, University of Pittsburgh, Pennsylvania.
authors.forename: Krissy K
authors.initials: KK
authors.lastname: Moehling
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Brendan
authors.initials: B
authors.lastname: Flannery
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Thompson
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Fry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data; D049674:History, 21st Century; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000188:drug therapy* / Q000266:history / Q000517:prevention & control*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D012306:Risk; D012621:Seasons
chemical_list: D000998:Antiviral Agents
keywords: ambulatory care; antiviral treatment; influenza; neuraminidase inhibitors