JAMA Netw Open
Telemedicine tied to lower antibiotic use for kids’ respiratory infections in primary care
Clinical takeaway: Consider primary care–based telemedicine as a first-line option for uncomplicated pediatric respiratory infections—it may lower unnecessary antibiotic use without compromising short-term outcomes.
Pediatric respiratory infections drive high antibiotic use—often unnecessarily—making care models that safely reduce prescribing critical for antimicrobial stewardship.
In a large cross-sectional study of 694 US primary care practices, telemedicine visits for pediatric acute respiratory tract infections (ARTIs) were associated with significantly lower antibiotic prescribing than in-person care. Among 449,630 index visits (mean age 6.6 years), antibiotics were prescribed in 34.6% of telemedicine visits vs. 46.8% of in-person visits—a 12.1–percentage point reduction after adjustment.
Despite fewer prescriptions, quality measures were similar. Guideline-concordant antibiotic management occurred in 85.5% of telemedicine visits vs. 86.2% in-person (difference −0.7 percentage points), indicating no meaningful compromise in appropriateness. Follow-up care within 14 days and subsequent antibiotic use also didn’t differ significantly between groups.
Diagnosis patterns varied: telemedicine visits more often received viral diagnoses (66.9% vs. 55.6%) and less frequently acute otitis media (11.0% vs. 26.3%), while sinusitis diagnoses were more common (14.7% vs. 4.9%). Importantly, lower prescribing persisted across demographic subgroups, with no group showing increased antibiotic use via telemedicine.
As the authors note, “telemedicine integrated within primary care was associated with 12-percentage-point–lower antibiotic prescribing…without increased follow-up visits,” suggesting effective stewardship without missed diagnoses.
The findings contrast with prior concerns about overprescribing in direct-to-consumer telemedicine and highlight the value of continuity within primary care. Expanding telemedicine access in these settings may help reduce unnecessary antibiotic exposure while maintaining care quality.
Source: Ray KN, et al. (2026, May 1). JAMA Netw Open. Primary Care Telemedicine vs In-Person Antibiotic Prescribing for Pediatric Respiratory Tract Infections