Paediatric antibiotic prescribing in a nationwide direct-to-consumer telemedicine platform in France, 2018-2021

Bénédicte Melot; Elise Launay; Florian Drouet; Julie Salomon; Julie Toubiana; Julien Grosjean; Catherine Duclos; Jérémie F Cohen

doi:10.1093/jacamr/dlae070

Paediatric antibiotic prescribing in a nationwide direct-to-consumer telemedicine platform in France, 2018-2021

JAC Antimicrob Resist. 2024 May 8;6(3):dlae070. doi: 10.1093/jacamr/dlae070. eCollection 2024 Jun.

Authors

Bénédicte Melot^{1

2

3}, Elise Launay^{4

5}, Florian Drouet², Julie Salomon^{2

6}, Julie Toubiana⁷, Julien Grosjean^{1

8}, Catherine Duclos¹, Jérémie F Cohen^{7

9}

Affiliations

¹ Sorbonne University Paris Nord, Laboratory of Medical Informatics and Knowledge Engineering in e-Health, LIMICS, Sorbonne University, INSERM, Bobigny, France.
² Qare, Medical Team, Paris, France.
³ Department of infectious diseases, Hospital of Vannes, Vannes, France.
⁴ Department of Pediatrics and Pediatric Infectious Diseases, Nantes University Hospital, Nantes, France.
⁵ Nantes University of Medicine, Nantes, France.
⁶ Department Pediatric Gastroenterology, Hepatology, and Nutrition, Necker Hospital for Sick Children, Université Paris Cité, Paris, France.
⁷ Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Université Paris Cité, Paris, France.
⁸ Department of Digital Health, Rouen University Hospital, Rouen, France.
⁹ Inserm UMR 1153-Centre of Research in Epidemiology and Statistics (CRESS), EPOPé Team, Université Paris Cité, Paris, France.

Abstract

Background: Recent regulatory and reimbursement changes facilitated the development of teleconsultation within primary care. French guidance advises against antibiotic prescribing in children in teleconsultation. We assessed paediatric antibiotic prescribing on a French teleconsultation platform.

Methods: This cross-sectional observational study analysed paediatric (0-14 years) visits on a national direct-to-consumer teleconsultation platform between January 2018 and December 2021. Teleconsultations with complete information regarding diagnosis (ICD-10 coding) and prescriptions were included. We assessed antibiotic prescription rates per 100 visits across diagnoses and used logistic regression to identify factors associated with antibiotic prescribing.

Results: In the 37 587 included paediatric teleconsultations (median age 3 years) performed by 713 general practitioners (GPs) and 89 paediatricians, antibiotics were prescribed for 12.1%. Respiratory tract infections (RTIs) accounted for 49.5% of antibiotic prescriptions. Antibiotic prescription rates per 100 visits were: sinusitis, 69.5%; urinary tract infections, 62.2%; pharyngitis, 59.0%; pneumonia, 45.5%; otitis, 46.6%; bronchitis, 19.6%; rhinitis, 11.6%; bronchiolitis 6.6%. Antibiotic prescription rates were higher in GPs than paediatricians [OR 2.21 (IC95% 2.07-2.35)], among physicians aged 45-54 and over 65 [OR 1.66 (1.48-1.85) and 1.48 (1.32-1.66), respectively], in female practitioners [OR 1.13 (1.05-1.21)], in children 3-6 years old [OR 1.41 (1.28-1.56)] and over 6 [OR 1.50 (1.35-1.66)], during winter [OR 1.28 (1.21-1.37)] and for RTIs [OR 1.99 (1.87-2.10)]. Antibiotic prescription rates were lower in doctors with extensive experience in teleconsultation [OR 0.92 (0.86-0.98)].

Conclusions: Despite current recommendations, paediatric patients were frequently prescribed antibiotics during acute care teleconsultations. Specific antibiotic stewardship campaigns should target paediatric teleconsultations.