Telehealth in Pediatric Primary Care Linked to Lower Antibiotic Prescribing for Respiratory Infections

Children seen via telehealth visits integrated into primary care practices were significantly less likely to receive antibiotics for acute respiratory tract infections (ARTIs) than those seen during in-person visits, according to a national retrospective study presented at the 2025 Pediatric Academic Societies (PAS) Meeting.

The findings, based on an analysis of more than 540 000 pediatric ARTI episodes across 843 US pediatric and family medicine practices, showed that antibiotics were prescribed in 16.3% of telemedicine (TM) index visits compared with 46.9% of in-person (IP) visits (P < .001). Telehealth visits also had a lower rate of bacterial diagnoses (13.3% TM vs 44.4% IP, P < .001). The most common bacterial diagnoses in both groups were acute otitis media, streptococcal pharyngitis, and sinusitis.

“These findings show that when used in the context of a primary care practice, telehealth can allow primary care physicians to provide treatment that aligns with guidelines,” presenting author Samuel Wittman, MS, research data analyst at the University of Pittsburgh, said in a PAS press release. “Integrating telehealth into pediatric primary care allows pediatricians more options for getting children connected to the right care at the right time, especially for families with time, transportation, or financial barriers.”

Judicious prescribing was also observed in measures of guideline-concordant antibiotic use. Among visits with bacterial diagnoses, 90.0% of TM episodes followed prescribing guidelines, compared with 85.9% of IP visits (P < .001). Researchers also found that although follow-up visits occurred more often after TM encounters, the rate of additional antibiotic prescribing within 14 days of the initial visit did not differ significantly between TM and IP groups (1.9% vs 3.7%, P = .15).

The study authors noted that previous analyses of telehealth, especially in direct-to-consumer models, raised concerns about antibiotic overuse. However, the present findings indicate that when telehealth is embedded within a medical home model, antibiotic management may be more appropriate.

The study excluded visits that were well-child checks or included co-diagnoses likely to require antibiotics. Of the children represented in the analysis, 48.3% were Medicaid-insured and 10.8% were from Spanish-speaking households. Telehealth accounted for 2.3% of all index visits.

The research supports the integration of telehealth into pediatric primary care as a tool for expanding access while maintaining high standards of antibiotic stewardship, according to the authors.

Reference: Study: Telehealth in pediatric primary care supports judicious antibiotic prescribing. News release. Pediatric Academic Societies. April 25, 2025. Accessed April 29, 2025. https://www.eurekalert.org/news-releases/1081703