We defined the appropriate indications for an oseltamivir prescription as suspected influenza infection, suspected exposure to someone with influenza, or anticipation of travel to countries where avian influenza infection had previously been reported in humans and/or birds. To determine the indication for the oseltamivir prescription, electronic medical records were reviewed. 2 We thus identified a period when there was a high probability that a prescription for oseltamivir was intended for stockpiling and not for treatment of a true influenza infection. This period correlates with a period of intense media coverage of avian influenza, a marked increase in the number of oseltamivir prescriptions written nationally, and an absence of influenza in the surrounding geographic area. We identified individuals who received prescriptions for oseltamivir by use of an electronic medical record and order system during the period from September 1, 2005, to December 31, 2005. Given this context, our study aimed to do the following: (1) assess individuals’ reasons for receipt of an oseltamivir prescription between September and December 2005, (2) determine the extent to which oseltamivir prescribed during this period was later used inappropriately by patients, and (3) compare knowledge, understanding, concerns, and expectations regarding avian influenza among persons who obtained oseltamivir for probable stockpiling and persons who did not obtain this drug.Ī cross-sectional study was performed involving patients who received care in the outpatient Clinical Practices of the University of Pennsylvania Health System. Elucidation of these issues may help illuminate the impact of personal stockpiling and develop public health responses or strategies aimed at minimizing this practice, if necessary, during future threats of pandemic illness and/or bioterrorism.

Furthermore, as far as we know, researchers have not examined the knowledge, beliefs, concerns, and/or expectations regarding avian influenza of patients who stockpiled oseltamivir. To our knowledge, no studies have examined patient-level prescribing and/or usage patterns for oseltamivir in particular, there has apparently been no examination of prescribing practices and usage patterns for the oseltamivir that was prescribed out of proportion to influenza activity during periods of heightened media coverage of avian influenza. 1 The potential ramifications of self-medication with antimicrobial drugs include the propagation of antimicrobial resistance, unwarranted risk of adverse events, and suboptimal care for individuals who should receive more extensive clinical evaluation. Antimicrobials dispensed in anticipation of an outbreak may also be used inappropriately to treat illnesses other than those for which the drugs were intended. Therefore, a clearer elucidation of the issues surrounding personal stockpiling is warranted.Īlthough stockpiling may be useful in specific contexts and certain situations, haphazard and panicked personal stockpiling of antimicrobials could decrease the availability of drugs for persons with active infection and prevent the strategic use of a limited drug supply when it is needed. In light of emerging infectious diseases and the ongoing threat of bioterrorism, personal stockpiling of other drugs in response to public health threats is likely to occur in the future. 1 Subsequently, despite the fact that human cases of H5N1 influenza virus infection continue to occur, public awareness has diminished, and the demand for oseltamivir has markedly decreased. So much oseltamivir had been prescribed prior to the start of influenza season that the drug’s manufacturer suspended shipments to the United States at the end of October 2005. During the fall of 2005, reports of personal stockpiling of oseltamivir for use during a future outbreak of H5N1 influenza virus infection were widespread, coincident with increased media coverage of the potential for a worldwide pandemic.

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