A new study provided a road-map for changing how acute respiratory infections, including influenza, are treated.

The report from CDC researchers emphasized the importance of the following:

• Eliminating antibiotic treatment of viral upper respiratory tract infections and bronchitis,

• Improving influenza diagnosis and treatment, and

• Reinforcing prescription guidelines for pharyngitis and sinusitis.

The article in JAMA Network Open pointed out that, among 14,987 outpatients with acute respiratory infections enrolled in this cohort study during influenza seasons, 41% were prescribed antibiotics, 41% of whom had diagnoses for which antibiotics are not indicated, primarily viral upper respiratory tract infections and bronchitis. In addition, 29% of patients with influenza confirmed through research testing were prescribed antibiotics instead of other treatments such as antivirals.

Pink and gray pills. Source

“Inappropriate antibiotic prescribing exposes patients to the risks of unnecessary antibiotics and represents a potential missed opportunity for patients to benefit from influenza antiviral medications,” study authors wrote. “Clinicians should be encouraged to consider influenza as a clinical diagnosis during the influenza season, refrain from prescribing antibiotics in situations in which they are not recommended by guidelines, and prescribe influenza antiviral medications when indicated.”

Noting that acute respiratory infections (ARIs) are the syndrome for which antibiotics are most commonly prescribed, even though most are caused by viruses, the study team sought to characterize antibiotic prescribing among outpatients with ARI during influenza season and to identify targets for reducing inappropriate antibiotic prescribing for common ARI diagnoses. Outpatients with laboratory-confirmed influenza were among the participants.

Conducted during the 2013-2014 and 2014-2015 influenza seasons, the cohort study enrolled outpatients aged 6 months or older with ARI evaluated at outpatient clinics associated with 5 US Influenza Vaccine Effectiveness Network sites. All patients underwent influenza testing by real-time reverse transcriptase–polymerase chain reaction for research purposes only.

Researchers gathered information on antibiotic prescriptions, medical history, and International Classification of Diseases, Ninth Revision diagnosis codes from medical and pharmacy records, as well as group A streptococcal (GAS) testing results in a patient subset.

The focus was on healthcare visits  for ARI, defined by a new cough of 7 days’ duration or less, and antibiotic prescriptions received within seven days of enrollment. . Diagnosis codes, clinical information, and influenza and GAS testing results were used to determine the appropriateness of antibiotic prescribing.

Overall, 14,987 patients with ARI -- mean age of 32, 58% women and 80% white--  were prescribed an antibiotic. Yet, the CDC researchers pointed out that 41% had diagnoses for which antibiotics are not indicated, most, 84%, of whom had a viral upper respiratory tract infection or bronchitis (acute or not otherwise specified).

Among the 22% of patients not diagnosed as having pneumonia and who had laboratory-confirmed influenza, 29% were prescribed an antibiotic, accounting for 17% of all antibiotic prescriptions among patients with non-pneumonia ARI.

Most of the patients with pharyngitis, 91%, had group A streptococcal testing, with 35% receiving antibiotics, even though 38% had negative results on the GAS test.  The study team also wrote about 1,200 patients with sinusitis and no other indication for antibiotic treatment who received an antibiotic; 38% had symptoms for 3 days or less prior to the outpatient visit, suggesting acute viral sinusitis not requiring antibiotics.

“Antibiotic overuse remains widespread in the treatment of outpatient ARIs, including among patients with laboratory-confirmed influenza, although study sites may not be representative of other outpatient settings,” study authors concluded. “Identified targets for improved outpatient antibiotic stewardship include eliminating antibiotic treatment of viral upper respiratory tract infections and bronchitis and improving adherence to prescribing guidelines for pharyngitis and sinusitis. Increased access to sensitive and timely virus diagnostic tests, particularly for influenza, may reduce unnecessary antibiotic use for these syndromes.”