Are antibiotics indicated in patients with severe autoimmune disorders who test positive for influenza?

From the Guidelines

Antibiotics in Severe Autoimmune Disorders with Influenza

Antibiotics are not routinely indicated in patients with severe autoimmune disorders who test positive for influenza, unless there is evidence of a secondary bacterial infection.

• The decision to use antibiotics should be based on the presence of worsening symptoms, such as recrudescent fever or increasing dyspnea, or the presence of lower respiratory features in patients at high risk of complications or secondary infection 1.
• According to the Infectious Diseases Society of America, clinicians should test for influenza in high-risk patients, including immunocompromised persons, and consider antiviral treatment if the testing result will influence clinical management 1.
• The British Infection Society guidelines suggest that antibiotics should be considered in patients with worsening symptoms or those at high risk of complications, and that the preferred choice includes co-amoxiclav or a tetracycline, with macrolides or fluoroquinolones as alternative options 1.
• Co-amoxiclav 625 mg tds PO or doxycycline 200 mg stat and 100 mg od PO are recommended as initial empirical antibiotic treatment regimens for non-pneumonic lower respiratory tract infections complicating influenza 1.
• It is essential to note that most patients can be adequately treated with oral antibiotics, and the switch from parenteral to oral antibiotics should be made as soon as clinically appropriate 1.

From the Research

Antibiotic Use in Patients with Severe Autoimmune Disorders and Influenza

• The use of antibiotics in patients with severe autoimmune disorders who test positive for influenza is not directly addressed in the provided studies 2, 3, 4, 5, 6.
• However, the studies suggest that antibiotics are often overprescribed for acute respiratory infections, including influenza 3, 5.
• Influenza vaccination is recommended for patients with autoimmune disorders to prevent severe influenza infections, which can be complicated by the use of immunosuppressive therapies 2, 4, 6.
• The prevention strategy and clinical management of infections in patients with autoimmune disorders need to be individually tailored, taking into account the characterization of the disease, the mechanism of action of immunosuppressive drugs, and the patient's risk factors 2.
• There is no clear evidence to support the routine use of antibiotics in patients with severe autoimmune disorders who test positive for influenza, and antibiotic use should be guided by clinical judgment and evidence-based guidelines 3, 5.

Influenza Vaccination and Autoimmune Disorders

• Influenza vaccination is effective in preventing influenza infections in patients with autoimmune disorders, although the antibody response may be lower compared to healthy controls 4, 6.
• Patients with systemic inflammatory and/or autoimmune diseases have an increased risk of severe influenza infections, and annual vaccination is recommended to prevent these infections 6.
• The use of immunosuppressive therapies may increase the risk of infections, and vaccination is an important preventive measure 2, 6.

Antibiotic Prescribing Practices

• Antibiotic overuse remains a concern in the treatment of outpatient acute respiratory infections, including influenza 3, 5.
• Targets for improved outpatient antibiotic stewardship include eliminating antibiotic treatment of viral upper respiratory tract infections and bronchitis, and improving adherence to prescribing guidelines for pharyngitis and sinusitis 5.
• Increased access to sensitive and timely virus diagnostic tests, particularly for influenza, may reduce unnecessary antibiotic use for these syndromes 3, 5.