As telemedicine visits increase, so do the chances of overprescribing of antibiotics to children, according to a new study.

Children with acute respiratory infections were prescribed antibiotics more often during direct-to-consumer telemedicine visits than during in-person appointments or urgent care visits, according to UPMC Children’s Hospital of Pittsburgh research reported Monday in “Pediatrics,” the official peer-reviewed journal of the American Academy of Pediatrics.

The researchers looked at a national health plan database covering 4 million children in the U.S. annually and contracts with a direct-to-consumer telemedicine vendor.

The analysis showed that children received antibiotic prescriptions during 52% of telemedicine visits, compared with 42% of urgent care and 31% of primary care provider visits. Compared to primary care and urgent care visits, the antibiotics received at telemedicine visits also were less likely to be consistent with clinical guidelines, according to the study.

“In recent years, the use of telemedicine for acute, primary care concerns has increased among children,” said lead author Dr. Kristen Ray, an assistant professor of pediatrics at University of Pittsburgh School of Medicine. “We know very little about the care children receive during these direct-to-consumer telemedicine visits, which occur with doctors outside of the child’s usual pediatric office.”

The differences in antibiotic prescribing found in this analysis were much larger than differences found in similar analyses of direct-to-consumer telemedicine visits by adults, according to Ray.

“As a general pedicatrician, I’m interested in making care easier and less burdensome for families, and I think there are many technological innovations that aim to do this,” Ray said. “But I think it also is important to make sure the quality of the care that children receive remains high.”

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