RT Journal Article SR Electronic T1 Antibiotic prescribing for acute infections in synchronous telehealth consultations: a systematic review and meta-analysis JF BJGP Open JO BJGP Open FD Royal College of General Practitioners SP BJGPO.2021.0106 DO 10.3399/BJGPO.2021.0106 A1 Mina Bakhit A1 Emma Baillie A1 Natalia Krzyzaniak A1 Mieke van Driel A1 Justin Clark A1 Paul Glasziou A1 Christopher Del Mar YR 2021 UL http://bjgpopen.org/content/early/2021/11/08/BJGPO.2021.0106.abstract AB Background Antibiotic overprescribing is a major concern that contributes to the problem of antibiotic resistance.Aim To assess the effect on antibiotic prescribing in primary care of telehealth (TH) consultations compared with face-to-face (F2F).Design & setting Systematic 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). Studies were included that compared synchronous TH consultations (phone or video-based) to F2F consultations in primary care.Method PubMed, Embase, Cochrane CENTRAL (inception–2021), clinical trial registries and citing–cited references of included studies were searched. Two review authors independently screened the studies and extracted the data.Results Thirteen studies were identified. The one small randomised controlled trial (RCT) 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, were 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 non-significant higher prescribing in the TH group. Bronchitis showed no change in prescribing.Conclusion The impact of TH on prescribing appears to vary between conditions, with more increases than reductions. There is insufficient evidence to draw strong conclusions, however, and higher quality research is urgently needed.