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. 2019 Apr 26;6(6):ofz192.
doi: 10.1093/ofid/ofz192. eCollection 2019 Jun.

Influenza Antiviral Prescribing Practices and the Influence of Rapid Testing Among Primary Care Providers in the US, 2009-2016

Ashley L Fowlkes  1 , Andrea Steffens  1 , Carrie Reed  1 , Jonathan L Temte  2 , Angela P Campbell  1 ; Influenza Incidence Surveillance Project Working Group
Collaborators, Affiliations

Influenza Antiviral Prescribing Practices and the Influence of Rapid Testing Among Primary Care Providers in the US, 2009-2016

Ashley L Fowlkes et al. Open Forum Infect Dis. .

Abstract

Background: Early influenza antiviral treatment within 2 days of illness onset can reduce illness severity and duration. Reliance on low sensitivity rapid influenza diagnostic tests (RIDTs) to guide antiviral prescribing has been reported. We describe antiviral prescribing practices among primary care providers from a large surveillance network in the United States.

Methods: From 2009-2016, a network of 36 to 68 outpatient clinics per year collected respiratory specimens and clinical data for patients with influenza-like illness (ILI). Specimens were tested for influenza using polymerase chain reaction (PCR). We used multivariable logistic regression to assess factors influencing antiviral prescribing.

Results: Among 13 540 patients with ILI, 2766 (20%) were prescribed antivirals. In age groups recommended to receive empiric antiviral treatment for suspected influenza, 11% of children <2 years and 23% of adults ≥65 years received a prescription. Among 3681 patients with a positive PCR test for influenza, 40% tested negative by RIDT. In multivariable analysis, prescription receipt was strongly associated with a positive RIDT (adjusted odds ratio [aOR] 12, 95% CI 11-14) and symptom onset ≤2 days before visit (aOR 4.3, 95% CI 3.8-4.9). Antiviral prescribing was also more frequent among pediatric and private family practice clinics compared with community health centers (aOR 1.9, 95% CI 1.6-2.2, and 1.3, 95% CI 1.1-1.5, respectively).

Conclusion: Primary care providers were more likely to prescribe antivirals to patients with a positive RIDT, but antivirals were prescribed infrequently even to patients in high-risk age groups. Understanding patient and provider characteristics associated with antiviral prescribing is important for communicating treatment recommendations.

Keywords: antiviral treatment; influenza; neuraminidase inhibitors; primary care.

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Figures

Figure 1.
Figure 1.
Annual influenza antiviral prescribing among primary care patients presenting with influenza-like illness (ILI) according to rapid influenza detection test (RIDT) results, 2009—2016.
Figure 2.
Figure 2.
Antiviral prescribing and molecular detection of influenza among primary care patients with influenza-like illness by season, 2009–2016.
See this image and copyright information in PMC

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