The influence of rapid influenza diagnostic testing on antibiotic prescribing patterns in rural Thailand

Rapid influenza diagnostic testing is potentially a useful means to decrease inappropriate prescription of antibiotics. We studied the impact of access to rapid influenza test results on antibiotic prescribing and other patient management practices for outpatients with influenza-like illness (ILI) in a rural province in Eastern Thailand.

A medical record review was performed for 300 patients of all ages selected from five outpatient departments using a 1:2 ratio of ILI cases with and without influenza infection identified by the QuickVue rapid test. Chi-square analysis or Fisher's exact test was used to compare patient management practices (antibiotic prescriptions, individual treatments administered, additional tests ordered, and related hospitalization) between rapid test positive and negative patients. Logistic regression was used to evaluate the effect of rapid test results on patient management practices for ILI.

Eighty-two percent of all patients with ILI were prescribed antibiotics. Patients with a positive rapid test were less likely to be prescribed antibiotics than those with a negative result (73% vs. 87%, respectively, p=0.003). The likelihood of antibiotic prescription for influenza positive patients was 0.41 times the likelihood for influenza negative patients (95% CI 0.23-0.74, p=0.003). There was no significant difference in the frequency of other patient management practices between influenza positive and negative patients.

Thai outpatients with ILI are prescribed antibiotics at a frequency approximately twice that reported in the USA. Having access to a rapid influenza test result was associated with a significant decrease in antibiotic prescription. Improved access to rapid influenza testing and expanded physician education may reduce inappropriate antibiotic use and improve patient care.