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

Mina Bakhit,Natalia Krzyzaniak,Paul Glasziou,Justin Clark,Christopher Del Mar,Mieke Van Driel,Emma Baillie

doi:10.3399/bjgpo.2021.0106

Abstract

BackgroundAntibiotic overprescribing is a major concern that contributes to the problem of antibiotic resistance.AimTo assess the effect on antibiotic prescribing in primary care of telehealth (TH) consultations compared with face-to-face (F2F).Design & settingSystematic review and meta-analysis of adult or paediatric patients with a history of a community-acquired acute infection (respiratory, urinary, or skin and soft tissue). Studies were included that compared synchronous TH consultations (phone or video-based) to F2F consultations in primary care.MethodPubMed, Embase, Cochrane CENTRAL (inception–2021), clinical trial registries and citing–cited references of included studies were searched. Two review authors independently screened the studies and extracted the data.ResultsThirteen studies were identified. The one small randomised controlled trial (RCT) found a non-significant 25% relative increase in antibiotic prescribing in the TH group. The remaining 10 were observational 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 TH consultations, whereas the two studies of acute otitis media showed a significant increase. Pharyngitis, conjunctivitis, and urinary tract infections showed non-significant higher prescribing in the TH group. Bronchitis showed no change in prescribing.ConclusionThe impact of TH on prescribing appears to vary between conditions, with more increases than reductions. There is insufficient evidence to draw strong conclusions, however, and higher quality research is urgently needed.

Highlights

IntroductionAntibiotic prescribing is a major concern that contributes to the problem of antibiotic resistance. InAustralia, more than 41% of the population received at least one antibiotic in 2017,2 and 80% of antibiotic prescriptions occurred in primary care.3In primary care antibiotics are frequently prescribed for self-limiting acute respiratory infections (ARIs) such as; middle ear infections, acute bronchitis, and sore throat, where antibiotics have little benefits and may cause harms (such as vomiting, diarrhoea and rash).Before the coronavirus pandemic in 2019 (COVID-19), several strategies (such as delayed prescribing) and campaigns (such as the Choosing Wisely campaigns) aimed to reduce antibiotic prescribing
Antibiotic prescribing is a major concern that contributes to the problem of antibiotic resistance.1 InAustralia, more than 41% of the population received at least one antibiotic in 2017,2 and 80% of antibiotic prescriptions occurred in primary care.3In primary care antibiotics are frequently prescribed for self-limiting acute respiratory infections (ARIs) such as; middle ear infections, acute bronchitis, and sore throat,4 where antibiotics have little benefits5-8 and may cause harms.Before the coronavirus pandemic in 2019 (COVID-19), several strategies and campaigns aimed to reduce antibiotic prescribing
Acute infections are commonly treated with antibiotics adding to the problem of antibiotic resistance

Summary

Introduction

Antibiotic prescribing is a major concern that contributes to the problem of antibiotic resistance. InAustralia, more than 41% of the population received at least one antibiotic in 2017,2 and 80% of antibiotic prescriptions occurred in primary care.3In primary care antibiotics are frequently prescribed for self-limiting acute respiratory infections (ARIs) such as; middle ear infections, acute bronchitis, and sore throat, where antibiotics have little benefits and may cause harms (such as vomiting, diarrhoea and rash).Before the coronavirus pandemic in 2019 (COVID-19), several strategies (such as delayed prescribing) and campaigns (such as the Choosing Wisely campaigns) aimed to reduce antibiotic prescribing. In. Australia, more than 41% of the population received at least one antibiotic in 2017,2 and 80% of antibiotic prescriptions occurred in primary care.. In primary care antibiotics are frequently prescribed for self-limiting acute respiratory infections (ARIs) such as; middle ear infections, acute bronchitis, and sore throat, where antibiotics have little benefits and may cause harms (such as vomiting, diarrhoea and rash). Before the coronavirus pandemic in 2019 (COVID-19), several strategies (such as delayed prescribing) and campaigns (such as the Choosing Wisely campaigns) aimed to reduce antibiotic prescribing. In Australia antibiotics are usually prescribed in a face-to-face consultation with general practitioners. In the era of COVID-19, remuneration for telehealth was introduced and many clinicians have shifted to deliver patient care remotely to decrease the risk of transmission.

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