Patients with influenza virus were more likely to be given antibiotics — which are mostly useless and probably harmful — than antiviral medication, according to a major review of prescriptions during the 2012-2013 flu season. Worse, doctors only prescribed antivirals to about one in five of the patients most likely to benefit from them.
"Our study demonstrates that clinicians are still more likely to prescribe antibiotic than antiviral medications to outpatients with influenza, including to high-risk patients who would benefit" from them, the authors wrote. While sometimes antibiotics are useful for fighting infections caused by the flu, "it is likely that most of the prescriptions were unnecessary." The paper, from doctors at the Centers for Disease Control and Prevention, appears in the journal Clinical Infectious Diseases on Thursday.
It confirms doctors still distribute antibiotics far too often, despite the rise of drug-resistant bacteria and with apparent disregard for side effects antibiotics can cause. An editorial accompanying the article, Michael G. Ison, of Northwestern University, admonished his fellow doctors: "We are failing our patients."
"Significant effort has been directed at optimizing antibiotic utilization, but this report suggests that overuse is still common for patients presenting with influenza," Ison wrote. "Prescribing antiviral therapy to a patient without influenza has minimal risk of inducing resistance, whereas prescribing antibiotics to a patient without a bacterial infection affects the patient’s microbiome and contributes to the emergence of antibiotic resistance."
In a 2013 report, the CDC breathlessly urged doctors to conserve the power of antibiotics, which it calls a "limited resource." When an antibiotic is used, bacteria learn to withstand its effects, producing a resistant strain. The consequences are fatal. An estimated 23,000 people die every year because of drug-resistant bacteria. Although people can acquire a drug-resistant infection anywhere, the most common places are hospitals.
In the new study, doctors combed through thousands of patient records in five states and examined what happened to 6,766 people who came to outpatient clinics with acute respiratory illness. About one-third of them turned out to have the flu, yet just 15 percent of those with the flu were prescribed antiviral medication.
And only 19 percent of the patients who had heightened risk factors — including infants, the elderly, and people with chronic illnesses — were given an antivirus. The authors note the recommended antivirus medication has no adverse side effects and can greatly reduce the possibility of needing antibiotics later. Meanwhile, doctors gave 30 percent of their flu patients one of three antibiotics included in the study. (The authors said the percentage could have been higher if more antibiotics had been tested.)
Here's what this means: Doctors were declining to give drugs that could be effective and have no down side, but were frequently ordering medication that has virtually no benefit and can be seriously harmful. Why? That question wasn't part of the study. But many people say it's partly because patients (and their worried parents) want antibiotics and doctors are too happy to oblige them. When patients have made the effort to see a doctor, they don't want to be told to go home and get some rest — they want something out of it. Besides, doctors are keen to treat an infection if they can.
But epidemiologists say this practice isn't sustainable. "A significant educational effort needs to be directed to the types of physicians who are caring for these patients," Ison wrote. "This effort needs to include specific efforts to understand how these providers approach patients with respiratory illness and their current knowledge about the risks and benefits of various potential therapies for patients with influenza."
Source: Havers F, et al. Use of Influenza Antiviral Agents by Ambulatory Care Clinicians During the 2012-2013 Influenza Season. Clinical Infectious Diseases. 2014.