March 09, 2015
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Few high-risk patients receive antivirals when presenting with possible flu

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During the 2013-2014 influenza season, only 15% of patients with acute respiratory illness at high-risk for influenza complications were prescribed an antiviral medication when presenting to care within 2 days of symptom onset, CDC researchers reported.

Among the 2,786 patients at higher risk for influenza complications, however, only 30% presented to care within 2 days of symptom onset.

“Current guidance recommends that clinicians treat high-risk outpatients with suspected influenza empirically, without waiting for confirmatory laboratory testing, as neuraminidase inhibitors are most effective if prescribed as soon as possible after symptom onset,” the researchers wrote in Clinical Infectious Diseases. “We found that 70% of high-risk patients presented to care more than 2 days after symptom onset, including 75% of adults aged 65 years [or older] with [acute respiratory illness] symptoms and 58% of those with laboratory-confirmed influenza.”

Fiona P. Havers, MD, MHS, of the CDC’s Influenza Division, and colleagues analyzed data from 6,004 adults and children seeking care for acute respiratory illness at ambulatory care centers from Dec. 2, 2013 to April 20, 2014. They identified patients at high-risk for influenza complications and evaluated when they presented to care and if they were prescribed Tamiflu (oseltamivir, Genentech) or Relenza (zanamivir, GlaxoSmithKline).

Among the 6,004 outpatients, 46% were considered high-risk due to age, chronic medical conditions, obesity, pregnancy or American Indian or Alaska Native race. Among the entire cohort, 7% of patients were prescribed a neuraminidase inhibitor, and among the high-risk patients, 7% were prescribed neuraminidase inhibitors. Among the 835 high-risk patients who presented within 2 days of symptoms, 15% received a prescription. Among all patients, 21% had laboratory-confirmed influenza, including 16% of the high-risk patients.

“Fewer than half of the influenza-infected outpatients seeking care for an [acute respiratory illness] and at high risk for influenza-associated complications presented to care early enough for optimal neuraminidase inhibitor treatment,” the researchers wrote. “Thus, to optimize care and potentially reduce the risk of influenza-associated complications, high-risk patients should be educated to contact their provider promptly after the onset of [acute respiratory illness] symptoms during the influenza season.” – by Emily Shafer

Disclosure: Havers reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.