Antibiotic prescribing for acute infections in synchronous telehealth consultations: a systematic review and meta-analysis

Abstract

Background: Antibiotic overprescribing is a major concern that contributes to the problem of antibiotic resistance.Aim: To assess the effect on antibiotic prescribing in primary care of telehealth (TH) consultationscompared with face-to-face(F2F).Design & setting: Systematic review and meta-analysisof adult or paediatric patients with a historyof a community-acquiredacute infection (respiratory, urinary, or skin and soft tissue). Studies wereincluded that compared synchronous TH consultations (phone or video-based)to F2F consultationsin primary care.Method: PubMed, Embase, Cochrane CENTRAL (inception–2021), clinical trial registries and citing–cited references of included studies were searched. Two review authors independently screened thestudies and extracted the data.Results: Thirteen studies were identified. The one small randomised controlled trial (RCT) found anon-significant25% relative increase in antibiotic prescribing in the TH group. The remaining 10 wereobservational studies but did not control well for confounding and, therefore, were at high risk of bias.When pooled by specific infections, there was no consistent pattern. The six studies of sinusitis —including one before–after study — showed significantly less prescribing for acute rhinosinusitis in THconsultations, whereas the two studies of acute otitis media showed a significant increase. Pharyngitis,conjunctivitis, and urinary tract infections showed non-significanthigher prescribing in the TH group.Bronchitis showed no change in prescribing.Conclusion: The impact of TH on prescribing appears to vary between conditions, with more increasesthan reductions. There is insufficient evidence to draw strong conclusions, however, and higher qualityresearch is urgently needed