Telemedicine May Boost Unnecessary Antibiotic Prescribing in Kids

By Megan Brooks

August 03, 2019

NEW YORK (Reuters Health) - Antibiotics are often prescribed to children with respiratory tract infections (RTIs) during video-only direct-to-consumer (DTC) telemedicine visits, and parents are more satisfied with the video visit when it results in a prescription, a new study has found.

In email to Reuters Health, lead author Dr. Charles Foster from the Center for Value-Based Care Research at the Cleveland Clinic, in Ohio, said, "Telemedicine offers a convenient means for patients to access timely care for minor medical problems. It's popular with patients and use of the platform will likely increase in the future. That doesn't mean that there isn't room for improvement, both from a technological point of view and with regard to how telemedicine physicians provide care."

For example, he noted that guidelines from major societies recommend that children with pharyngitis should only be treated for strep throat if a throat swab is positive.

"You really can't make that diagnosis without swabbing the child's throat. Telemedicine providers can triage patients during the video conference. Those in need of throat cultures should be referred to an urgent care center for a throat swab," said Dr. Foster.

For their study, online today in Pediatrics, the researchers reviewed "encounter" data from a nationwide DTC telemedicine platform. Of more than 12,800 RTI encounters with 560 physicians, antibiotics were prescribed in 55%, most commonly amoxicillin (55%), amoxicillin clavulanate (17%), azithromycin (12%), cefdinir (6%) and penicillin (3%).

Getting an antibiotic prescription correlated strongly with parent satisfaction with the video visit.

In fact, it was the strongest single predictor of satisfaction, and a physician's antibiotic prescribing rate was highly correlated with their overall satisfaction ratings, they report.

"Our data set did not provide us with the ability to review charts to validate the appropriateness of prescribing practices," Dr. Foster cautioned.

Video visits at which antibiotics were prescribed tended to be shorter, "presenting a second incentive for physicians to prescribe unnecessary antibiotics," the authors note in their report.

Summing up, Dr. Foster said, "Antibiotic overuse contributes to antibiotic-resistant bacteria and has additional untoward consequences. Increasing attention has been devoted to following the principles of judicious antibiotic prescribing for upper-respiratory-tract infections in pediatrics. It's important that physicians follow these guidelines regardless of the site of their practice, traditional ambulatory, urgent care or a telemedicine platform."

The study had no external funding and the authors have indicated no relevant conflicts of interest.


Pediatrics 2019.