Influenza is associated with substantial morbidity and mortality. Given this, antiviral therapy is commonly prescribed in an effort to prevent these outcomes. We therefore found it surprising that antivirals seem to make little difference for individuals with influenza in outpatient settings, even in the optimized setting of randomized clinical trials.1

Guidance from the US Centers for Disease Control and Prevention and others generally encourage treatment of influenza with antivirals.2 For outpatients with risk factors, as well as their household contacts, antiviral therapy is recommended on the basis that it might help. For outpatients without risk factors, antiviral therapy may nonetheless be prescribed based on clinical judgment. In either case, pressure to start treatment as early as possible means that antivirals are often prescribed without diagnostic testing for influenza or thoughtful consideration of their benefits and risks.