Less than half of people at high risk for flu complications took a popular antiviral medication when they sought outpatient care, according to a study published recently in Open Forum Infectious Diseases.

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Oseltamivir is recommended "as soon as possible" by the Centers for Disease Control and Prevention (CDC) for people seeking outpatient treatment for influenza if they are at higher risk for complications. This group includes people over the age of 64, those under 2 years old, or people with certain health conditions, such as asthma or heart disease.

Yet in a study of the 2023-2024 and 2024-2025 influenza seasons, a team led by researchers from the CDC found that only 42% of high-risk patients started oseltamivir (Tamiflu) treatment—compared with 36% for lower-risk patients and 39% for flu patients overall. Of high-risk patients, only 42% finished the medication course, which the study defined as taking 10 or more doses. 

The study found that kids under age 2 were the least likely to finish the full oseltamivir course, compared with adults aged 18 to 50 years. Also, being high-risk for complications didn't make people more likely to take 10 or more doses. 

Among all patients—not just those who were high risk—only about one in four (27%) who sought care at an emergency department ended up starting oseltamivir. In contrast, half of those who sought non-emergency care, like at a walk-in clinic, took the medication. 

The researchers didn't ask whether the medication was prescribed, only if patients took it and for how long. Also, the study gathered data at academic medical centers in central Tennessee, New York City, and St. Louis, Missouri, so treatment patterns and outcomes might have differed if patients came from other settings. 

Still, the authors argue that a better understanding of oseltamivir initiation and treatment completion can help evaluate clinical outcomes, which in turn helps determine whether prescribing patterns for outpatients need improvement. 

A national quality improvement initiative aimed at improving use of first-line antibiotics at pediatric urgent care centers was associated with increased use of shorter antibiotic prescriptions, researchers reported last week in the Journal of the Pediatric Infectious Diseases Society.

The study, led by researchers at Children’s Mercy in Kansas City, was a secondary analysis of data from a quality improvement collaborative at 92 pediatric urgent care centers in 22 states and Washington, DC. The collaborative, which was designed to reduce sociographic differences in first-line antibiotic selection in children with acute respiratory infections (ARIs), did not have antibiotic duration as a target. 

But the study authors explain that, because antibiotic stewardship efforts “may shift multiple prescribing dimensions simultaneously,” they wanted to evaluate whether the collaborative had any impact on antibiotic duration. They note that while several medical societies recommend five to seven days of antibiotics for most ARIs, 10-day prescriptions remain common, “underscoring a gap between evidence and practice that contributes to unnecessary antibiotic exposure.”

Among 257,859 encounters with antibiotic prescriptions from April 2022 through September 2024, acute otitis media (AOM, ear infection) was the most common diagnosis (62%).

Overall, prescriptions of seven days or less increased from 33.4% during the period before the collaborative (April 2022 through September 2023) to 35.9% during the intervention (October 2023 through April 2024) and 37.8% post-collaborative (May 2024 through September 2024). The most significant shift was observed in children with sinusitis (11.2% pre-collaborative to 33.9% post-collaborative). 

Compared with the pre-collaborative period, the odds of receiving a prescription of seven days or fewer rose by 22% (adjusted odds ratio [AOR], 1.22) during the intervention and 31% (AOR, 1.31) post-collaborative.

The authors say that while the improvements in duration were modest, they suspect elements of the collaborative “reinforced guideline awareness and supported system-level culture change leading to spillovers from antibiotic selection to duration.” 

“These findings suggest that stewardship initiatives targeting one aspect of prescribing behavior may have favorable spillover effects on other prescribing practices,” they wrote.