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Telemedicine Visits for Children with Respiratory Infections May Increase Antibiotic Overprescribing


With more insurance plans covering telemedicine visits, which connect families with clinicians outside their child's usual practice through their smartphones and other devices when a child is sick, new research suggests the trend may fuel antibiotic overprescribing. The May 2019 Pediatrics study, “Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits” (published online April 8), showed antibiotics were prescribed for children diagnosed with acute respiratory infections substantially more often during telemedicine visits than during in-person primary care provider and urgent care visits. For the study, which was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health, researchers examined claims data from a large, national health plan that covers over 4 million children annually and contracts with a direct-to-consumer telemedicine vendor. Focusing on visits for acute respiratory tract infections like ear infections, sinusitis, and viral colds, the study team found that children received antibiotic prescriptions during more than half (52 percent) of direct-to-consumer telemedicine visits, compared with 42 percent urgent care and 31 percent primary care provider visits. The differences were mostly due to differences in prescribing during visits where children were diagnosed with a viral infection -- among these visits, antibiotics were prescribed much more often during telemedicine visits compared to other settings. Antibiotics don’t help with these viral infections, and when prescribed too often can contribute to the rising rates of antibiotic-resistant disease. Study authors said the findings raise concerns about the quality of antibiotic prescribing for children via direct-to-consumer telemedicine. The American Academy of Pediatrics discourages direct-to-consumer telemedicine visits outside a child’s medical home for acute illnesses because of limited physical exam capabilities, limited access to medical records, and the lack of ongoing clinician-patient relationships – all of which are especially important when children are too young to describe their symptoms well. 

Editor’s note: The commentary, “Need an Antibiotic? There’s an App for That,” by Jeffrey S. Gerber, MD, PhD, FAAP, accompanies this study.


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit and follow us on Twitter @AmerAcadPeds