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

Abstract

BackgroundAntibiotic prescribing 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 to 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). We included studies that compared synchronous TH consultations (phone or video based) to F2F consultations in primary care.MethodWe searched PubMed, Embase, Cochrane CENTRAL (inception-2021), clinical trial registries and citing-cited references of included studies. Two review authors independently screened the studies and extracted the data.ResultsWe identified 13 studies. The one small randomised controlled trial 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 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 not-significant higher prescribing in the TH group. Bronchitis showed no change.ConclusionsThe impact of telehealth on prescribing appears to vary between conditions with more increases than reductions. However, there is insufficient evidence to draw strong conclusions, and higher quality research is urgently needed.

Impact of COVID-19 on broad-spectrum antibiotic prescribing for common infections in primary care in England: a time-series analyses using OpenSAFELY and effects of predictors including deprivation

“…found that the impact of telehealth consultations on antibiotic prescribing varied between conditions. 40 That study highlighted there was a significant decrease in antibiotic prescribing for acute rhinosinusitis during telehealth consultations. However, they observed an increase in antibiotic prescribing for acute otitis media during telehealth consultations.…”

Clinical practice review on telehealth for managing a population with chronic urinary tract infections during the COVID-19 pandemic

“…The process of retrieving the literature and selecting the articles included in this review has been illustrated in a flow diagram (Figure 1) which complied with the RIGHT checklist for reporting a clinical practice review. Of the six publications included within this review, five were review papers (10)(11)(12)(13)(14) and one was an observational study (15). The authors of the five review papers had evaluated current literature on the effectiveness of telehealth for a patient population group with lower urinary tract symptoms and UTI and expressed the significance of implementing telehealth during the COVID-19 pandemic.…”

“…Telemedicine has been regarded as an essential method for patient review and follow-up during the COVID-19 pandemic particularly for LUTS cases secondary to UTI (12). Somani et al (15) lay emphasis the impact of virtual urological services being the optimal method of minimizing service disruption and Bakhit et al has shown that telehealth treatment prescribing for UTI does not differ from face to face, and is an effective method of distanced management of the disease (14). Although telehealth has evolved and is a convenient method of managing a population with chronic UTI, challenges may be present in a population who are not digitally competent which is evident through the lack of digital skills, comprehension of how to use health technologies and technophobia (10,12).…”

International travel in the pandemic era: Implications for health advice

“…8 This includes evidence that the shift to telemedicine is associated with increased antibiotic prescribing. 9 Antibiotic monitoring by the US Centers for Disease Control and Prevention (CDC) showed an increase in antibiotic use as clinicians face uncertainty as to whether a respiratory infection is due to SARS-CoV-2 or another cause. 10 A review of data from COVID-19 cases, mostly in Asia, found that more than 70% of patients received antimicrobial treatment.…”