Pediatric Telemedicine May Reduce Antibiotic Use for Respiratory Infections
Pediatric primary care telemedicine can support careful antibiotic use for acute respiratory tract infections without lowering short-term care quality
For children with acute respiratory tract infections, telemedicine visits integrated into primary care were linked with fewer antibiotic prescriptions than in-person visits, while guideline-concordant antibiotic management and short-term follow-up outcomes were similar.
Study Details
Acute respiratory tract infections are among the most common reasons children are seen in primary care. These illnesses include viral upper respiratory infections, acute otitis media, streptococcal pharyngitis, and bacterial sinusitis. Symptoms often overlap, including cough, congestion, sore throat, ear pain, and fever, which can make antibiotic decisions challenging.
The study, published in JAMA Network Open on May 1, 2026, examined whether antibiotic prescribing differed between telemedicine and in-person pediatric primary care visits. This distinction matters because earlier concerns about telemedicine often focused on direct-to-consumer virtual care, where clinicians may not know the child, may not have full access to records, and may have fewer options for in-person reassessment. In this study, the telemedicine visits were integrated into primary care practices, meaning they occurred within the child’s usual care setting.
Methodology
Researchers analyzed electronic health record data from 694 U.S. pediatric and family medicine primary care practices. The study included visits for children younger than 18 years with acute respiratory tract infections between January 1 and December 31, 2023. The dataset included 438,148 in-person visits and 11,482 telemedicine visits among 302,817 children, with a mean age of 6.6 years.
Because this was not a randomized trial, the researchers used propensity score weighting. In plain language, that means they tried to make the telemedicine and in-person groups more comparable by accounting for factors such as age, race, ethnicity, medical complexity, geography, prior healthcare use, season of visit, and clinic specialty.
The main outcomes were whether antibiotics were prescribed at the initial visit and whether antibiotic management matched guideline expectations for the diagnosis. The researchers also looked at follow-up visits and antibiotic prescriptions within 14 days after the first visit.
Key Findings
Antibiotics were prescribed in 34.6% of telemedicine visits compared with 46.8% of in-person visits after weighting, a difference of about 12 percentage points.
Guideline-concordant antibiotic management was similar between visit types, at 85.5% for telemedicine and 86.2% for in-person care.
Follow-up visits and later antibiotic prescriptions within 14 days did not differ significantly by visit type, suggesting there was no clear rebound effect after telemedicine visits.
Telemedicine visits more often resulted in diagnoses of viral infections and sinusitis, while in-person visits more often resulted in diagnoses of acute otitis media and streptococcal pharyngitis.
A key limitation was that the researchers could not distinguish audio-only visits from video visits, and telemedicine made up only about 2% of acute respiratory infection visits in the dataset.
Implications for Practice
For parents and caregivers, the study supports a balanced message. A virtual visit with a child’s own primary care practice may be appropriate for many respiratory symptoms, especially when the concern is cough, congestion, mild sore throat, or a likely viral illness. This does not mean every child should be seen virtually. Ear pain, breathing difficulty, dehydration, persistent high fever, severe throat symptoms, or a clinician’s concern for pneumonia, acute otitis media, or strep throat may still require in-person evaluation.
For healthcare providers, the findings suggest that primary care telemedicine can be used as a stewardship tool when it is embedded in a medical home. The ability to review records, counsel families, arrange follow-up, and convert a virtual visit to an in-person assessment may reduce “just-in-case” antibiotic prescribing. The invited JAMA Network Open commentary emphasized that telemedicine within primary care differs from direct-to-consumer platforms, where prior studies found higher antibiotic prescribing and lower guideline concordance.
Clinically, the study also raises an important diagnostic question. In-person visits produced more diagnoses of acute otitis media and streptococcal pharyngitis, conditions that often drive antibiotic use. Telemedicine cannot visualize the tympanic membrane and cannot perform rapid strep testing, so practices need clear triage protocols. A practical approach is to use telemedicine for initial assessment when appropriate, while maintaining low-friction pathways for in-person examination or testing when warning signs or diagnostic uncertainty are present.
For antibiotic stewardship programs, the opportunity is not simply to expand telemedicine. The opportunity is to expand the right kind of telemedicine: primary care connected, record informed, guideline supported, and designed with reliable follow-up. This model may help reduce unnecessary antibiotic exposure while preserving timely access for families.