Primary care telemedicine reduces antibiotic prescribing
Among children with acute respiratory tract infections, primary care telemedicine visits had fewer antibiotic prescriptions than in-person visits without more follow-up care.
*Retrospective cross-sectional comparative study; Level 2c (OCEBM).

Citation

Ray KN, Wittman SR, Kelly MK, et al. Primary care telemedicine vs in-person antibiotic prescribing for pediatric respiratory tract infections. JAMA Network Open. 2026;9(5):e2610062. doi:10.1001/jamanetworkopen.2026.10062.

Background

Acute respiratory tract infections are a leading reason children visit primary care and receive antibiotics, many of which may be unnecessary. Prior work suggested higher antibiotic use in telemedicine outside primary care; quality within primary care was unclear.

Patients

Children younger than 18 years seen at 694 US pediatric and family medicine primary care clinics (2023). Excluded: pneumonia, bronchiolitis, COVID-19, influenza; well visits; other diagnoses needing antibiotics; missing key demographic/region data.

Intervention

Telemedicine primary care index visit.

Control

In-person primary care index visit.

Outcome

Antibiotic prescribed; antibiotic management matching guidelines for the recorded diagnosis; follow-up visits and later antibiotics within 14 days.

Follow-up Period

14 days.

Results

Outcome (weighted) In-person Telemedicine Absolute difference
Antibiotic prescribed (primary) 46.8% 34.6% -12.1 percentage points (95% CI, -19.3 to -5.0); NNT≈9
Viral infection diagnosis 55.6% 66.9% +11.3 points (95% CI, 4.5 to 18.2)
Middle ear infection diagnosis 26.3% 11.0% -15.3 points (95% CI, -18.5 to -12.1)
Sinus infection diagnosis 4.9% 14.7% +9.9 points (95% CI, 4.2 to 15.6)
Analyses used propensity-score weighting to balance measured differences between visit types.

Limitations

Observational design cannot rule out unmeasured differences between patients choosing telemedicine vs in-person care. Diagnoses were taken from records (no independent confirmation), and follow-up outside primary care (urgent care or emergency visits) was not captured. Telemedicine visits were uncommon (about 2% of included visits), and the data could not reliably separate video from audio-only visits.

Funding

US National Institutes of Health; additional support from American Academy of Pediatrics and others.

Clinical Application

Offer telemedicine within established primary care for children with respiratory symptoms to reduce antibiotic use while monitoring diagnosis patterns and ensuring easy in-person escalation.