Adherence to Oseltamivir Guidelines during Influenza Pandemic, the Netherlands

sistance in Klebsiella pneumoniae due to the New Delhi metallo-β-lactamase. Delhi metallo-beta-lactamase 1–pro-ducing Enterobacteriaceae: emergence and response in Europe. To the Editor: In the Netherlands, the outbreak of pandemic infl uenza A (H1N1) 2009 led to a 100-fold increase from 2008 in prescriptions for the antiviral neuraminidase inhibitor oseltamivir (1). The guidelines for prescribing oseltamivir during the 2009 pandemic were adapted throughout the year. After August 7, prescribers were advised to restrict prescriptions to patients with infl uenza symptoms plus 1 additional risk factor (2) (Table). Community pharmacists dispensed oseltamivir as a 5-day course of sachets produced exclusively for the Dutch government program and documented all prescriptions. Our objective was to assess whether oseltamivir dispensed through community pharmacies was prescribed according to the national guideline for the pandemic virus and to investigate how patients used oseltamivir. The Institutional Review Board of the Division of Pharmacoepidemiology and Clinical Pharmacology of Utrecht University approved the study. Pharmacists in 19 pharmacies belonging to the Utrecht Pharmacy Practice Network for Education and Research (UPPER) selected all patients who had fi lled a prescription for oseltamivir during May 1, 2009– February 8, 2010. These patients were contacted by phone and, after giving consent, completed a structured questionnaire. The questionnaire contained questions about potential risk factors, the reason for receiving the oseltamivir prescription (infl uenza symptoms or other reasons), and whether the oseltamivir course was started and completed. Of the 630 patients eligible for contact, 361 (57.3%) completed the questionnaire. To assess whether the current guidelines were adhered to, because of the changes in policy throughout the year, we analyzed only the 300 respondents who had fi lled the oseltamivir prescription at the height of the pandemic, i.e., after August 7, 2009. A total of 156 (52.0%) participants were female patients; most participants were 18–59 years of age. Of the 212 patients >18 years of age, education level was available for 195; of these, 55 (28.2%) had a low education level, 94 (48.2%) a middle education level, and 46 (23.6%) a high education level. Of the 300 respondents, 111 (37.0%) received a prescription while they did not meet guideline criteria (Table). They had risk factors but did not experience infl uenza symptoms (67 [22.3%] of all respondents); had infl uenza symptoms but not risk factors (34 [11.3%]); or had neither infl uenza symptoms nor any risk factors (10 [3.3%]). Compared with respondents who had a low …