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Neuraminidase inhibitor use in adults presenting to hospital with suspected influenza: a questionnaire-based survey of practice among hospital physicians

Neuraminidase inhibitor use in adults presenting to hospital with suspected influenza: a questionnaire-based survey of practice among hospital physicians
Neuraminidase inhibitor use in adults presenting to hospital with suspected influenza: a questionnaire-based survey of practice among hospital physicians
Background: UK Public Health England (PHE) guidelines recommend the liberal use of neuraminidase inhibitors (NAIs) in hospitalised adults with suspected influenza and are aligned with international guidelines. NAI use is recommended to start as early as possible and empirical use is recommended whilst awaiting laboratory results. Current UK hospital physician knowledge, attitudes, and practises regarding the use of NAIs, and levels of adherence to guideline recommendations are not known.

Methods: this online, cross-sectional questionnaire-based survey of self-reported prescribing practice using clinical scenarios, was distributed to secondary care physicians involved in the assessment of adults presenting to hospital with suspected influenza. The primary outcome measure was adherence to PHE guidelines.

Results: there were 237 respondents to the survey. 157 (67%) of 233 respondents reported awareness of PHE guidelines. Adherence to guidelines in the clinical scenarios ranged from 56% (95% CI 49-63%) to 72% (95% CI 66-79%) with considerable variability between specialities (p=0.0008). Not treating suspected cases was common as was withholding of NAIs whilst awaiting laboratory results, despite the acknowledgment of prolonged turnaround times. 73 of 220 (33%) respondents reported that concerns about NAI efficacy influenced their prescribing.

Conclusions: concordance with national guidelines for the treatment of influenza is sub-optimal. Lack of guideline awareness and concerns over the effectiveness of NAIs are contributing factors. This study highlights a disparity between public health policy and clinical practice and suggests that strategies that promote rapid diagnostic testing and adherence to treatment guidelines are required.

Study registration

This study is registered with the ISRCTN:18249297
Influenza, Neuraminidase inhibitor, Oseltamivir, Survey
2590-1702
Brendish, Nathan
a8a4189e-01eb-4ab3-933e-a24cd188a4d7
Malachira, Ahalya K
c4df54f3-faca-4abb-b360-6555048c18f3
Lillie, Patrick J
5c886b60-9574-4531-8a01-909a62f283f3
Clark, Tristan
712ec18e-613c-45df-a013-c8a22834e14f
Brendish, Nathan
a8a4189e-01eb-4ab3-933e-a24cd188a4d7
Malachira, Ahalya K
c4df54f3-faca-4abb-b360-6555048c18f3
Lillie, Patrick J
5c886b60-9574-4531-8a01-909a62f283f3
Clark, Tristan
712ec18e-613c-45df-a013-c8a22834e14f

Brendish, Nathan, Malachira, Ahalya K, Lillie, Patrick J and Clark, Tristan (2021) Neuraminidase inhibitor use in adults presenting to hospital with suspected influenza: a questionnaire-based survey of practice among hospital physicians. Clinical Infection in Practice, 11, [100075]. (doi:10.1016/j.clinpr.2021.100075).

Record type: Article

Abstract

Background: UK Public Health England (PHE) guidelines recommend the liberal use of neuraminidase inhibitors (NAIs) in hospitalised adults with suspected influenza and are aligned with international guidelines. NAI use is recommended to start as early as possible and empirical use is recommended whilst awaiting laboratory results. Current UK hospital physician knowledge, attitudes, and practises regarding the use of NAIs, and levels of adherence to guideline recommendations are not known.

Methods: this online, cross-sectional questionnaire-based survey of self-reported prescribing practice using clinical scenarios, was distributed to secondary care physicians involved in the assessment of adults presenting to hospital with suspected influenza. The primary outcome measure was adherence to PHE guidelines.

Results: there were 237 respondents to the survey. 157 (67%) of 233 respondents reported awareness of PHE guidelines. Adherence to guidelines in the clinical scenarios ranged from 56% (95% CI 49-63%) to 72% (95% CI 66-79%) with considerable variability between specialities (p=0.0008). Not treating suspected cases was common as was withholding of NAIs whilst awaiting laboratory results, despite the acknowledgment of prolonged turnaround times. 73 of 220 (33%) respondents reported that concerns about NAI efficacy influenced their prescribing.

Conclusions: concordance with national guidelines for the treatment of influenza is sub-optimal. Lack of guideline awareness and concerns over the effectiveness of NAIs are contributing factors. This study highlights a disparity between public health policy and clinical practice and suggests that strategies that promote rapid diagnostic testing and adherence to treatment guidelines are required.

Study registration

This study is registered with the ISRCTN:18249297

Text
CIiP NAI paper revised clean - Accepted Manuscript
Available under License Creative Commons Attribution.
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More information

Accepted/In Press date: 16 March 2021
e-pub ahead of print date: 1 May 2021
Published date: 1 May 2021
Additional Information: Publisher Copyright: © 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: Influenza, Neuraminidase inhibitor, Oseltamivir, Survey

Identifiers

Local EPrints ID: 448946
URI: http://eprints.soton.ac.uk/id/eprint/448946
ISSN: 2590-1702
PURE UUID: 4799aba2-4a38-4b06-b37b-f35a65de4584
ORCID for Nathan Brendish: ORCID iD orcid.org/0000-0002-9589-4937
ORCID for Tristan Clark: ORCID iD orcid.org/0000-0001-6026-5295

Catalogue record

Date deposited: 11 May 2021 17:11
Last modified: 20 Apr 2024 02:12

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Contributors

Author: Nathan Brendish ORCID iD
Author: Ahalya K Malachira
Author: Patrick J Lillie
Author: Tristan Clark ORCID iD

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