Telehealth rivals in-person visits for judicious antibiotic prescribing in kids

HONOLULU — New study findings provided more promising data for primary care-based telehealth.

Researchers here reported the results of a study of more than a half-million pediatric encounters for acute respiratory tract infection, which found that physicians providing telehealth services integrated into a primary care practice were even more judicious in their antibiotic prescribing than physicians who saw children in the office.

A study by some of the same researchers published last year in JAMA Network Open had already allayed some concerns about the quality of antibiotic prescribing available via primary care-based telehealth. In particular, that study showed that children with acute respiratory tract infections received fewer antibiotics and required less follow-up care when their telehealth visit was conducted by a service attached to a primary care practice vs. a virtual-only direct-to-consumer company.

In the new study presented at PAS 2025, Samuel R. Wittman, MS, a research data analyst at the University of Pittsburgh School of Medicine, and colleagues retrospectively assessed more than 540,000 episodes of bacterial or viral acute respiratory tract infection that occurred among children at 843 primary care practices in the United States in 2023. They excluded any patients who were diagnosed during a well visit or had another illness that might require antibiotics.

The researchers used diagnosis codes to determine whether a telemedicine visit was for an acute respiratory tract infection. For each antibiotic prescription, they assessed whether providers followed guidelines for the type of antibiotic prescribed but did not assess whether the prescription was for the appropriate duration, another important aspect of antimicrobial stewardship.

Research has shown that acute respiratory tract infections are a leading cause of inappropriate antibiotic prescribing, and that inappropriate antibiotic prescriptions not only promote antimicrobial resistance but also increase adverse drug events.

“Acute respiratory tract infection visits — which include diagnoses like ear infections, strep throat, and sinusitis, as well as viral diagnoses — are some of the most common reasons for children to receive antibiotics, which is why it’s important to focus antibiotic stewardship on these visits,” Wittman told Healio in an email.

He noted that the CDC added telemedicine-related guidance to its Core Elements of Outpatient Antibiotic Stewardship in 2024.

“Our group has been working to call attention to both the need for attention to antibiotic stewardship in outpatient telehealth and the potential for high-quality antibiotic prescribing in outpatient telehealth,” Wittman said.

The new study found that antibiotics were prescribed in around 47% of in-person visits attributed to an acute respiratory tract infection compared with around 16% of telemedicine visits for the same type of illnesses, Wittman and colleagues reported.

The researchers used a logistical regression model to adjust the results for potential differences in the children who received care in-person or via telehealth and found that physicians providing care via telehealth still prescribed 12% fewer antibiotics compared with physicians who saw patients in-person, according to data presented at the meeting.

Moreover, physicians followed antibiotic prescribing guidelines 90% of the time during telehealth visits compared with a rate of around 86% for physicians during in-person appointments, the researchers determined.

“Overall,” Wittman said, “we found that acute respiratory tract infection visits conducted via telemedicine integrated within pediatric primary care had low rates of antibiotic prescribing and high rates of guideline concordance.”

References:

For more information:

Samuel R. Wittman, MS, can be reached at srw52@pitt.edu.