TOPLINE:

Among children receiving care for acute respiratory tract infections (ARTIs) in primary care, telemedicine visits resulted in antibiotic prescriptions in approximately one third of visits compared with nearly half of in-person visits, with similar rates of guideline-concordant management and no increase in subsequent visits or antibiotic prescriptions within 2 weeks.

METHODOLOGY:

• Researchers conducted a retrospective cross-sectional analysis of 449,630 visits for ARTIs in 302,817 children (mean age, 6.6 years; 51.4% boys) at 694 primary care practices in the US in 2023.
• They compared 438,148 in-person and 11,482 telemedicine visits by children diagnosed with bacterial and viral ARTIs across community health organizations, independent pediatric practices, and practice networks affiliated with large health systems.
• The primary outcomes were receipt of any systemic antibiotic prescription within 2 days of the index visit and receipt of antibiotic prescriptions concordant with guidelines for the visit diagnosis.
• Secondary outcomes were diagnosis mix, follow-up visits within 14 days, and antibiotic prescription within 14 days.

TAKEAWAY:

• Among weighted visits, antibiotic prescription occurred during 34.6% (95% CI, 27.0%-42.3%) of primary care telemedicine visits vs 46.8% (95% CI, 45.1%-48.4%) of in-person visits (difference, -12.1 percentage points; 95% CI, -19.3 to -5.0).
• Guideline-concordant antibiotic management did not differ significantly between primary care telemedicine visits and in-person visits (85.5% vs 86.2%).
• Telemedicine visits were associated with increased receipt of diagnoses of viral ARTIs (66.9% vs 55.6%; difference, 11.3 percentage points; 95% CI, 4.5-18.2) and sinusitis (14.7% vs 4.9%; difference, 9.9 percentage points; 95% CI, 4.2-15.6) and with decreased receipt of a diagnosis of acute otitis media (11.0% vs 26.3%; difference, -15.3 percentage points; 95% CI, -18.5 to -12.1).
• The proportions of follow-up primary care visits for ARTIs within 14 days and of subsequent antibiotic prescriptions within 14 days showed no significant difference based on visit modality.

IN PRACTICE:

“[The] study suggests that supporting primary care practices so that they can offer telemedicine visits, as well as guiding families so that they choose primary care telemedicine instead of less judicious sites, may help reduce a child’s exposure to unnecessary antibiotics,” the authors of the study wrote.

“Expanding access to telemedicine within the medical home and thoughtfully guiding families toward these sites of care may help reduce unnecessary antibiotic exposure at a population level,” experts wrote in an invited commentary.

SOURCE:

The study was led by Kristin N. Ray, MD, MS, of the Department of Pediatrics at the University of Pittsburgh School of Medicine in Pittsburgh. It was published online on May 1, 2026, in JAMA Network Open. The invited commentary was written by Matthew P. Kronman, MD, MSCE, of the Department of Pediatrics, University of Washington and Seattle Children’s Research Institute, Seattle, Washington and Rana F. Hamdy, MD, MPH, MSCE of the Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, and the Division of Infectious Diseases, Children’s National Hospital, Washington, DC.

LIMITATIONS:

An objective assessment of diagnosis beyond what was provided by the clinicians was not available. Follow-up was limited to primary care settings because data on emergency department and urgent care usage were unavailable. Audio-only and audio-video visits could not be distinguished.

DISCLOSURES:

This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with additional support from the National Institute of Allergy and Infectious Diseases. Infrastructure support was contributed by the American Academy of Pediatrics and the Health Resources Services Administration of the US Department of Health and Human Services. PCORnet provided additional support, having been developed with funding from the Patient-Centered Outcomes Research Institute and conducted with the Accelerating Data Value Across a National Community Health Center Network Clinical Research Network. Some authors disclosed receiving grants from various sources during the conduct of the study or outside the submitted work, and one of the authors reported receiving personal fees from the American Heart Association for consultation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.