5 Things to Know About Improving Antibiotic Use in Outpatient Telemedicine

Most human antibiotic use occurs in outpatient settings, and at least 28% of antibiotic use in US physician offices and emergency departments is unnecessary and contributes to the development of antimicrobial resistance, excess healthcare costs, and adverse drug events.^[1,2] Commercial companies and health systems have expanded outpatient healthcare using telemedicine, including for conditions for which antibiotics are frequently prescribed. CDC's Core Elements of Outpatient Antibiotic Stewardship principles and practices (see Figure below) can be adapted to optimize antibiotic prescribing in outpatient telemedicine.

Here are five things to know about improving antibiotic use in outpatient telemedicine settings.

1. Antibiotics are too often prescribed for respiratory conditions during telemedicine visits.

Whether during virtual or in-person visits, the most common conditions for which antibiotics are prescribed are acute respiratory infections.^[3,4] These include sinusitis, pharyngitis, acute bronchitis, acute otitis media, and viral upper respiratory infections. In both virtual and in-person outpatient visits, antibiotic prescribing for these conditions has been observed to be relatively similar and in excess of what is desired and recommended. This is concerning because outpatient antibiotic prescribing in the United States frequently provides minimal benefit — with up to 28% of antibiotic prescribing providing no benefit at all^[1]— and antibiotics are among the most common causes of emergency department visits for adverse drug events.