Australian doctors overprescribing flu antivirals

Research summary

Researchers from the University of Adelaide have found that doctors are prescribing antivirals (a class of drug that targets viruses) for flu patients who may not benefit from the medication. The study examined the prescription of medications among more than 4 million patients who had flu-like illness, from general practices across Australia. It found that the use of antivirals between 2015 and 2017 rose from 20% to 30%.

Current recommendations state that antivirals should generally only be prescribed to those patients at a high risk of developing complications from the flu, such as those patients with chronic heart or lung problems. In these select patients, antivirals can potentially shorten the length of illness, as well as lessen the symptoms and complications of the illness (eg. pneumonia).

However, the study found that patients with a low risk of complications were receiving just as many antivirals. One main concern of overprescribing antivirals, as with the overprescribing of any medication, is exposing patients to unnecessary side effects, some of which can be serious. Antivirals, for instance, increase the risk of nausea and vomiting, headache, kidney problems and psychiatric complications. Another concern is that excessive use of antivirals can lead to antimicrobial resistance.

Dr Carla Bernardo, lead author of the research paper, stated that: “Apart from the elderly, who are more likely to have a chronic condition, the majority of children or adults receive little if any benefit from taking antivirals, the exception being those young people with underlying disease.

It is very likely that most individuals aged under 65 do not need antivirals…”

A silver lining from the study was that the prescription of antibiotics for flu-like illness – a medication with no purpose in the treatment of uncomplicated flu – had reduced, in line with national and international efforts to reduce antibiotic resistance.

Commentary

This winter in Australia has already been described as a ‘horror’ flu season, with an unprecedented number of cases recorded across numerous states.1 Consequently, the number of people presenting to their GPs with flu-like illness, and asking for treatment, is also likely to be higher than usual.

Probably the most important take home message from this commentary is that routine vaccination is the most important intervention for preventing influenza and its complications. Antivirals are not, by any means, an appropriate substitute. Moreover, the most suitable approach to treatment for otherwise healthy patients who have the flu, remains symptom control (ie. simple pain relief for aches, paracetamol for high fever), rest and drinking plenty of fluids.²  

The decision to prescribe antivirals involves a risk-benefit analysis which needs to be tailored to each patient’s circumstances. Put simply, evidence that has guided the development of current national recommendations suggests that:²

1. i) For otherwise healthy patients, the risk of taking antivirals is greater than the likely benefit;
2. ii) For patients with certain chronic problems (see this link for an extensive list of relevant conditions), the benefit of taking antivirals is likely to be greater than the risk.

As always, the best course of action if you have any concerns or questions is to see your local health professional.