Association Between the Use of Antibiotics, Antivirals, and Hospitalizations Among Patients With Laboratory-confirmed Influenza

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Clinicians may prescribe antibiotics to influenza patients at high risk for bacterial complications. We explored the association between antibiotics, antivirals, and hospitalization among people with influenza.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A retrospective cohort study of patients with confirmed influenza with encounters during January 2011–January 2019 was conducted using data from the Veterans Affairs Informatics and Computing Infrastructure (VINCI). We compared inpatient hospitalizations (all-cause and respiratory) within 30 days of influenza diagnosis between 4 patient cohorts: (1) no treatment (n = 4228); (2) antibiotic only (n = 671); (3) antiviral only (n = 6492); and (4) antibiotic plus antiviral (n = 1415). We estimated relative risk for hospitalization using Poisson generalized linear model and robust standard errors.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Among 12 806 influenza cases, most were white men (mean age, 57–60 years). Those with antivirals only, antibiotic plus antiviral, and antibiotics only all had a statistically significant lower risk of all-cause and respiratory hospitalization compared to those without treatment. Comparing the antibiotic plus antiviral cohort to those who were prescribed an antiviral alone, there was a 47% lower risk for respiratory hospitalization (relative risk, 0.53 [95% confidence interval, .31–.94]), and no other statistical differences were detected.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Those prescribed an antiviral, antibiotic, or both had a lower risk of hospitalization within 30 days compared to those without therapy. Furthermore, intervention with both an antibiotic and antiviral had a lower risk of respiratory hospitalization within 30 days compared to those with an antiviral alone. Importantly, the absolute magnitude of decreased risk with antibiotic plus antiviral therapy is small and must be interpreted within the context of the overall risk of antibiotic usage.</jats:p> </jats:sec>

Lower antibiotic prescription rates in hospitalized COVID-19 patients than influenza patients, a prospective study

“…Prescription rates in our study were lower than or comparable to several international studies [35][36][37][38]. A recent study documented higher rates of 30-day respiratory disease readmission in influenza patients only treated with antivirals as compared to both antivirals and antibiotics, although the absolute differences in risk were low [39]. In COVID-19 patients early antibiotic prescriptions were significantly reduced from the first to second pandemic wave (from 49% to 27%, proportionally 76% and 65% of all prescriptions).…”

Influenza and COVID‐19: What does co‐existence mean?

“…In addition to commonly used neuraminidase inhibitors (NAIs) such as oseltamivir, the polymerase inhibitor baloxavir is an effective newer option that provides equal or improved efficacy compared to NAIs, including in patients with high risk of complications, as well as having the added convenience of a single-dose oral regimen. 38,39 Antiviral treatment of influenza reduces disease burden and decreases both mortality and hospitalization rates, [40][41][42] particularly in patients with secondary infections leading to pneumonia. 43 Within treatment guidelines, strategies should be considered to provide high-risk individuals with antivirals pre-emptively, to ensure patients are treated within the 48-hour window and healthcare systems are not overburdened.…”

Drug repurposing of dextromethorphan as a cellular target for the management of influenza

“…However, despite covariate adjustment for many relevant patient factors and performing propensity score matching, we cannot rule out the possibility of selection bias or residual confounding. For example, our previous work identified that antibiotics have the potential to impact hospitalization rates among patients diagnosed with influenza 35 . Therefore, we performed a sub‐analysis that included antibiotics (Table A3) as a covariate.…”