Reducing antibiotic use in influenza: challenges and rewards

Respiratory tract infections are a frequent cause of medical consultations. Although the majority of such infections are viral in aetiology, they account for three-quarters of all antibiotic consumption, since bacterial infections of the upper and lower respiratory tract, notably bronchitis, sinusitis and pneumonia, are the most frequent complications resulting from virus infections, especially influenza in adults and children. The resulting widespread use of antibiotics is a primary factor that drives the emergence of antibiotic resistance at both the local and regional levels. Recent surveys suggest that the proportion of patients with influenza-like illness who receive antibiotics is at least double the actual incidence of the infections for which the treatment is intended. Inappropriate prescribing needs to be tackled by encouraging more rigorous diagnosis, prevention and treatment of viral infections, specifically influenza. Although accurate diagnosis of influenza is challenging, rapid tests to identify the causative pathogen, e.g., RT-PCR tests for influenza viruses, are becoming more reliable and affordable. The use of antiviral drugs, particularly neuraminidase inhibitors, is a specific and effective way of preventing and treating influenza, and has been shown to reduce the incidence of complications and associated antibiotic use. In contrast to bacterial resistance to antibiotics, viral resistance to neuraminidase inhibitors is low, and their high specificity means that they cannot exert selection pressure on any other species. The widespread adoption of these principles may have a significant effect on antimicrobial use and resistance.