Telemedicine Reduces Antibiotic Use for Respiratory Infections

Children seen by primary care clinicians for acute respiratory tract infections are prescribed antibiotics less frequently during telemedicine appointments than during in-person visits, according to a retrospective cross-sectional study reported by MedPage Today on May 2, 2026.

The research, led by Kristin N. Ray, MD, of the University of Pittsburgh School of Medicine and published in JAMA Network Open, suggests that integrating virtual care into the primary care medical home may support more judicious prescribing practices.

Prescribing Rates and Study Scope

The study analyzed data from the Telemedicine Integrated into Pediatric Primary Care dataset, encompassing 694 primary care practices. These practices included independent pediatric offices, community health organizations, and networks affiliated with large health systems.

Researchers examined a total of 438,148 in-person visits and 11,482 telemedicine visits for acute respiratory tract infections among 302,817 children. The mean age of the patients was 6.6 years, and 51.4% were boys.

After applying propensity score weighting, the data revealed a statistically significant difference in antibiotic use. Antibiotics were prescribed in 34.6% of telemedicine visits, compared with 46.8% of in-person visits.

Diagnostic Drivers of the Difference

The disparity in prescribing rates appeared to be driven by the types of diagnoses made in each setting. Telemedicine visits were associated with more frequent diagnoses of viral infections and sinusitis, increasing by 11.3 and 9.9 percentage points, respectively, compared to in-person visits.

Conversely, in-person encounters led to more diagnoses of streptococcal pharyngitis and acute otitis media, increasing by 5.9 and 15.3 percentage points, respectively. Because conditions like acute otitis media (middle ear infections) and strep throat often require antibiotics, while viral infections do not, the diagnostic distribution explains the lower overall prescription rate for virtual visits.

Despite the difference in prescribing volume, the study found no significant differences between the two groups regarding antibiotic management guideline concordance. There were no significant differences in the rate of follow-up visits or the likelihood of a patient receiving an antibiotic prescription within 14 days after the initial visit.

Integrated Care vs. Direct-to-Consumer Models

The findings contrast with previous research regarding direct-to-consumer (DTC) telemedicine—services provided by virtual-only vendors rather than a patient’s established primary care provider.

According to the report, prior studies indicated that DTC telemedicine visits often resulted in more antibiotic prescribing and lower adherence to clinical guidelines than in-person primary care visits. These virtual-only models also showed higher prescribing rates than telemedicine integrated into primary care.

The difference suggests that when virtual care is embedded within a primary care practice, clinicians can maintain a level of care and stewardship consistent with established medical guidelines.

Public Health Implications

The reduction of unnecessary antibiotic prescriptions is a central goal of antimicrobial stewardship. Overprescribing antibiotics for viral respiratory infections, which do not respond to these drugs, is a primary driver of antimicrobial resistance.

By demonstrating that integrated telemedicine can lead to fewer prescriptions without compromising guideline concordance or increasing the need for follow-up care, the study provides evidence that virtual options can be a viable tool in reducing the global threat of drug-resistant bacteria.