Short CommunicationThe use of macrolides in the 2009 H1N1 virus infection outbreak: A survey of general practices in Japan
Introduction
In patients with influenza, there has been an increase in the severity of bacterial infections in the lung as well as the death rates [1]. Bacteria were isolated from pneumonia patients infected with the 2009 pandemic influenza A (A/H1N1 2009) virus, and these patients were treated with antibiotics [2]. Macrolide antibiotics (macrolides) have anti-inflammatory effects [3], and an improvement of respiratory symptoms was reported in children with influenza treated with clarithromycin [4]. On the basis of these findings, we hypothesized that physicians in Japan may have used antibiotics, including macrolides, during the A/H1N1 2009 outbreak. We retrospectively evaluated the use of antibiotics for the treatment of influenza and physicians' reasons for prescribing treatment.
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Materials and methods
This survey was conducted by EPOCA Marketing Co., Ltd. (Tokyo, Japan), an independent research company, in order to reduce selection bias. A total of 5000 physicians were randomly selected from a database of 34,000 physicians and they were invited to participate in an internet survey from May 12, 2010 to July 7, 2010. Consent forms were obtained from all physicians.
We evaluated the following parameters: (1) number of patients with influenza virus infection between July 2009 and March 2010; (2)
Results
A total of 313 physicians completed the survey, and 247 general practice physicians were included in this analysis. Sixty-six physicians were excluded from this analysis because of incomplete surveys (61) or other reasons (5).
The responding physicians (n=247) treated a combined total of 22,950 patients, and 73% of these patients were diagnosed using a rapid diagnostic kit. All patients were treated with anti-influenza drugs. Among the 247 physicians, a total of 126 (51%), who treated a combined
Discussion
In this study, half of the physicians prescribed antibiotics in combination with anti-influenza drugs because of their ability to treat secondary bacterial infections and their anti-inflammatory effects. Clarithromycin was the most frequently prescribed first-line drug.
Physicians were randomly selected and invited to participate in the survey, but only a small number of physicians (247 out of 5000, or 4.9%) replied to the questionnaire, which is a limitation of this study.
Macrolides have
Conclusions
Physicians prescribed antibiotics on the basis of the patients' conditions and symptoms according to the consensus to limit the use of antibiotics for patients with influenza [10].
Conflict of interest
Authors have no conflicts of interest.
Acknowledgments
We thank Naoto Keicho for his helpful advice on statistical analysis and all of the clinicians for participating in this study.
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