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Mother and child talking to doctor during telehealth visit.

Study results prompt call for guidelines on antibiotic prescribing via telehealth

August 4, 2022

The proportion of antibiotic prescriptions written during pediatric telehealth visits increased rapidly in the early months of the pandemic but decreased as in-office visits resumed, a new study showed.

More than half of antibiotics were prescribed via telehealth in the first three months of the COVID-19 pandemic, but that figure dropped to just 2% in the spring and summer of 2021, according to an analysis of telehealth and in-person visits from March 2020 to July 2021 at a pediatric primary care network.

“Telehealth is likely to remain important post-pandemic to meet consumer demand for access and comfort. If antibiotic stewardship is to be maintained in such a setting, the question arises of how to approach telehealth antibiotic prescribing,” authors wrote in “Trends in Telehealth Antibiotic Prescribing for Children through the COVID-19 Pandemic” (Payvandi L, et al. Pediatrics. Aug. 4, 2022).

During the 74-week study period, 37,772 patients had at least one in-person encounter with an antibiotic prescribed, and 6,298 had at least one telehealth encounter with an antibiotic prescribed.

On average, patients in the telehealth group were older than those in the in-person group (11 vs. 9 years). Those in the telehealth group were more likely to have commercial insurance, be White non-Hispanic, prefer the English language and have complex chronic disease.

Of the 55,926 visits during which an oral antibiotic was prescribed, 12.5% were conducted via telehealth and 87.5% in-person. The proportion of encounters with an antibiotic prescription that were performed via telehealth peaked at 52.1% the week of April 27, 2020, then declined to an average of 2.4% over the last four weeks of the study period.

The top five diagnostic categories for which antibiotics were prescribed included ear infections (30.8% of all encounters with an antibiotic prescribed), skin and subcutaneous tissue infections (21.8%), respiratory infections (18.8%), genitourinary infections (6.3%) and Lyme disease (3.8%).

For all categories, prescriptions via telehealth peaked in March or April 2020 and dropped to low levels by the last four weeks of the study. Telehealth prescriptions for ear infections dropped from 40% to an average of 0.9%, while those for Lyme disease infections declined from 92.9% to an average of 11.7% and skin and subcutaneous tissue infections dropped from 73.6% to an average of 3.1%.

With telehealth options likely to remain in place for patients, the authors said the analysis shows guidelines are needed on the appropriate use of antibiotic prescribing via telehealth.

“Skin and soft tissue and Lyme disease diagnoses remained the most common diagnoses associated with telehealth antibiotic prescribing after the acute pandemic phase and therefore may be targets for further research and guideline development on appropriate telehealth antibiotic prescribing,” the authors wrote.


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