By CoperNick

Mia Miller

June 3, 2020

Telemedicine is a modern resource for receiving healthcare through communications technology such as phone call and video chat. It has recently increased in popularity due to its convenience and cheaper cost, making healthcare more readily accessible for those who struggle to visit their primary care doctor.

Although telemedicine is a highly convenient way of providing healthcare, it may entail unintended complications. Concerns have been raised as to whether it increases rates of antibiotic prescription without indication to do so, particularly in consideration of children. This has been shown to be an issue in traditional in-person clinic settings but may be even more so when conducting consultations by telemedicine.

In their study, Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits, published by the journal, Pediatrics, researchers found that those who sought advisement through a telemedicine service had a higher percentage of antibiotics prescribed as treatment for the pediatric patient’s illness opposed to those who instead went to a traditional in-person clinic.

Overprescribing antibiotics results in negative short-term consequences such as unnecessary costs. Antibiotics, like all medications, may also induce adverse side effects, such as nausea, vomiting, diarrhea, and abdominal discomfort. On a long-term scale, this further contributes to the rise in antibiotic resistance, the persisting problem of bacteria becoming more resilient to the effects of antibiotics. There is a global exigency for new antibiotics, and the problem worsens by continual overprescribing of antibiotics.

As shown in the photo above, while bacteria that are susceptible to the drug are killed, bacteria that are resistant continue to proliferate, becoming more dominant in the population of bacteria.

Antibiotics work in a variety of ways depending on the type. For instance, some antibiotics can directly stop the replication of a bacteria by targeting its DNA topoisomerase or RNA polymerase, whilst others can trigger a stress response which contributes to its cell death. However, a fundamental concept to note is that antibiotics only work on bacteria. Overprescribing antibiotics is largely due to the many similarities between illnesses caused by bacterial infections and those that are caused by viruses. Because viral infections show similar signs and symptoms to bacterial infections, the difference can be hard to discern, especially through the means of telemedicine due to lack of a physical assessment of the patient.

Common viral infections affect the respiratory tract and are particularly frequent in pediatric patients. A common form of a lower respiratory tract infection in children is pneumonia, an infection of either the interstitial area of the lung, the alveoli, or both, and can be caused by bacteria, viruses, or fungi. Pneumonia presents similar signs and symptoms to other respiratory infections but can be more readily distinguished by a chest radiograph and analyzing typical signs through physical examination, such as inspiratory crackles upon auscultation. Furthermore, pneumonia caused by a bacterial infection can be distinguished from pneumonia caused by a viral infection through sputum samples.

Antiviral drugs are normally used for more rare and severe cases and respiratory tract infections commonly do not require specific treatment and will often be relieved on its own. Still, doctors may feel obligated to prescribe antibiotics to their patients even if they suspect it is unnecessary, so if the illness is indeed a bacterial infection, the doctor is not accused of negligence since he or she could have acted otherwise. Additionally, the doctor is more likely to err on the side of caution to ease the mind of the concerned parent when caring for pediatric patients. If the doctor’s main recommendation is for the patient to rest and stay hydrated, those who took the time to speak with the medical professional may feel as though they did not gain anything from the consultation. However, one must bear in mind the rising problem of antibiotic resistance and weigh their decision in consideration of long-term consequences.

Healthcare is meant to be designed so that the patient receives care which has benefits that outweigh the costs, which is not the case when prescribing antibiotics unnecessarily to patients with viral infections. For this reason, the American Telemedicine Association has recommended that telemedicine should not be used for those under the age of two. Even if there are no new restrictions on telemedicine, doctors must stay mindful of the long-term effects of overprescribing antibiotics, even if they must go against the demands of the patient.

Bibliography:

https://www.sciencedaily.com/releases/2019/04/190408114255.htm

https://pediatrics.aappublications.org/content/143/5/e20182491

Picture Credits:

https://sites.google.com/site/howdoantibioticskillbacteria/home/-how-do-bacterial-infections-lead-to-illness/why-and-how-do-bacteria-become-resistant-to-antibiotics/415819760_0998674ca7.jpg?attredirects=0

READ MORE ARTICLES AT THIS LINK