Friday, August 1, 2014

Study Finds Many Flu Patients Not Treated Appropriately

Antiviral drugs aren’t prescribed often enough for patients at high risk for flu complications, while too many of them receive unneeded antibiotics, a new study says.

The findings show that doctors require more training about the proper use of antiviral and antibiotic drugs in treating flu patients, the researchers said. Unnecessary use of antibiotics contributes to the development of antibiotic resistance.

“Our results suggest that during 2012-13, antiviral medications were under prescribed and antibiotics may have been inappropriately prescribed to a large proportion of the outpatients with influenza,” wrote Dr. Fiona Havers and colleagues from the U.S. Centers for Disease Control Prevention and several other institutions.

The researchers analyzed data from about 6,800 patients with flu symptoms seen at five outpatient care centers in Michigan, Pennsylvania, Texas, Wisconsin and Washington State during the 2012-13 flu season. The team focused on prescription records for two antiviral drugs for flu – oseltamivir (Tamiflu) and zanamivir (Relenza) – and three widely used antibiotics (amoxicillin-clavulanate, amoxicillin, and azithromycin).

Antiviral drugs were prescribed to only 19% of patients who were at high risk for flu complications and saw a primary care provider within two days of their flu symptoms emerging. And only 16% of patients with laboratory-confirmed flu got oseltamivir or zanamivir.

However, 30% of these patients were prescribed antibiotics, which are typically ineffective against flu unless it has progressed to a bacterial infection, according to the study. The study was published July 17 in the journal Clinical Infectious Diseases.

“Continuing education on appropriate antibiotic and antiviral use is essential to improve health care quality,” the researchers said.

The author of an accompanying editorial, Dr. Michael Ison, said benefits associated with antiviral therapy for influenza include fewer lower respiratory infections, hospitalizations, reduced antibiotic use and stroke risk.

The study “demonstrates that we are clearly failing our patients by not providing antiviral therapy to patients with influenza consistent with current guidelines while exposing many of the patients to antibiotics from which they likely derive little benefit,” wrote Ison, associate professor of infectious diseases and organ transplantation at the Northwestern University Feinberg School of Medicine in Chicago.

Antibiotic use to treat the flu is the apparent standard of care for the primary care physician despite current guidelines that clearly oppose this line of treatment. I have a hard time believing that it is lack of knowledge as any physician knows that antibiotics are ineffective against viral infections. In part, it may be lack of experience with antiviral medications.

The evidence is quite clear that antibiotics have detrimental effects on the patient, their immune system and more specifically the microbiome of the digestive tract. Please review my blog Serious Diarrheal Infection in Kids Linked to Antibiotics posted March 14, 2014.

The negative effects on the entire patient population have also been well documented with the emergence of MRSA and other antibiotic resistant bacteria directly linked to overuse of antibiotics. The best place to contract MRSA or C. difficile is any US hospital where antibiotic use is the standard of care.

If you are suffering from an upper respiratory infection or flu-like symptoms and decide to seek medical care; ask for a CBC (complete blood count) and throat culture. That will provide both you and your physician the knowledge to treat appropriately.

Source: NIH (National Institutes of Health) -Thursday, July 17, 2014