Pediatric telemedicine visits for Acute RTI linked to lower antibiotic use: JAMA
Researchers have found in a large cross-sectional study that children with acute respiratory tract infections were prescribed antibiotics less often during telemedicine visits compared to in-person consultations. This was mainly due to a higher rate of viral infection diagnoses in telemedicine, while in-person visits more frequently identified conditions like ear infections and strep throat. Importantly, there were no significant differences in guideline adherence, follow-up visits, or delayed antibiotic prescribing, suggesting that telemedicine can reduce antibiotic use without compromising quality of care. The study was published in JAMA Network Open by Kristin N. and colleagues.
In order to assess the clinical performance and safety of virtual pediatric care, a retrospective, cross-sectional analysis was performed on the clinical consultations conducted for the management of acute respiratory infections in children under the age of 18 years. In this analysis, the data from 694 primary care offices across the United States, ranging from community health organizations to private pediatric medical practices and large health systems, were analyzed. The statistical analyses were performed between October 1, 2024, and February 12, 2026, through an advanced methodological process that estimated the likelihood of having a virtual consultation and determined the average effect of the intervention through the use of a probability model. The key outcomes studied included the total percentage of initial consultations leading to antibiotic prescriptions and the percentage of those prescriptions conforming to clinical guidelines for the identified condition.
Key findings:
- A total of 449,630 encounters for pediatric patients with ARTIs was studied, which included 438,148 in-person encounters and 11,482 telemedicine encounters.
- These encounters included 302,817 pediatric patients with an average age of 6.6 years (±4.7 years).
- Antibiotic prescriptions were written in 34.6% (95% CI, 27.0%-42.3%) of telemedicine visits versus 46.8% (95% CI, 45.1%-48.4%) of in-person visits using the propensity-weighted model, indicating a substantial 12.1 percentage point decrease in antibiotic use in virtual visits.
- Compliance with the diagnostic criteria was remarkably similar; 85.5% (95% CI, 80.5%-90.4%) of telemedicine visits achieved guideline-concordant antibiotic management versus 86.2% (95% CI, 85.1%-87.3%) of in-person visits, with almost identical antibiotic use (a mere 0.7 percentage point difference).
- There was no significant variation in patients that needed follow-up in-person visits or a new antibiotic prescription within 14 days of their initial visit in both telemedicine and in-person groups.
This large cross-sectional study of pediatric primary care practices in the United States shows that telemedicine in conjunction with the medical home of a child leads to very prudent use of antibiotics and high levels of compliance with guidelines, without any increase in clinic visits or delayed use of antibiotics. This indicates that the provision of pediatric care through telemedicine does not per se result in either diagnosis problems or loose use of antibiotics. Instead, it is a great tool for modern-day antibiotic stewardship.
Reference:
Ray KN, Wittman SR, Kelly MK, et al. Primary Care Telemedicine vs In-Person Antibiotic Prescribing for Pediatric Respiratory Tract Infections. JAMA Netw Open. 2026;9(5):e2610062. doi:10.1001/jamanetworkopen.2026.10062
