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Put Down the Z-Pak

Antibiotics not working for flu patients.

As cold and flu season approaches, providers are preparing their arsenal of treatments. However, a common prescription threatens to do more harm than good to those who already have the flu.

Antibiotics used to treat bacterial versus viral infections are being prescribed to flu patients, according to the Centers for Disease Control and Prevention or CDC.

In fact, 42% of a total 14,487 flu patients that were seen at outpatient clinics were prescribed mostly broad-spectrum antibiotics during two consecutive flu seasons.

"If you're an outpatient clinician, a large proportion of your patients who are coming in during influenza season have influenza, and they don't benefit from antibiotics," said Fiona Havers, MD, MHS, of the CDC in Atlanta. "If [patients] come in, for example, with acute bronchitis, [they] should not be getting azithromycin."

Havers and other infectious disease experts call on both providers and patients to better educate themselves on what does and doesn't work in terms of treatment.

Christopher Crnich, MD, of the University of Wisconsin in Madison says in addition to determining if an antibiotic treatment is indicated, providers must be aware of another potentially harmful issue on the table.

"[Clinicians are] not only prescribing for unnecessary indications, they're tending to select the agents that carry a higher risk of harm," he noted.

The CDC looked at ICD-9 codes and prescription data from five locations in the U.S. Influenza Vaccine Effectiveness Network during the last two flu seasons, focusing on patients over the age of six months who have acute respiratory infections.

The data found that clinicians had prescribed broad-spectrum macrolides to nearly 50% of adults and about 20% of children. Crnich was quoted by MedPage explaining that macrolides have a potentially high risk for adverse events.

Nearly half of the flu patients who had received prescriptions had a secondary ailment such as sinusitis, otitis media or pharyngitis listed in their chart.

However, a subanalysis of the group, which looked at streptococcal testing done during the 2014-2015 flu season at four of the five sites, indicated more than half of those patients who were prescribed antibiotics were being treated for conditions where antibiotic treatment rarely or never applied.

The CDC reported that patients are not only getting improper treatment but that those treatments utilizing unnecessary antibiotics are contributing to the growing threat of bacterial resistance. At least two million people become infected with bacteria that are resistant to antibiotics every year, 23,000 of which die as a result of those bacterial infections, according to a CDC report, Antibiotic Resistance Threats in the United States, 2013. Thousands more die from other conditions complicated by an antibiotic-resistant infection.

They estimate that many as 49,000 people in a given season have had the flu and have died from it or as a result of complications. It's important for clinicians to better educate themselves on what works and doesn't work for treating flu patients who are likely to be a large portion of their clientele.

Crnich suggested primary care providers start with delaying antibiotic prescriptions and tend toward prescribing more narrow-spectrum drugs.

 Chelsea Lacey-Mabe is a staff writer at ADVANCE. Contact:

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