Antibiotic stewardship in direct-to-consumer telemedicine consultations leads to high adherence to best practice guidelines and a low prescription rate.

• Studies suggest that telemedicine (TM) increases antibiotic prescription rate. • We analyzed 6050 TM visits performed under rigorous antibiotic stewardship. • Most acute low-risk infectious conditions were adequately managed by TM. • TM under stewardship was associated with low and adequate antibiotic prescription. To analyze the antibiotic prescription rate in low-risk patients evaluated at a telemedicine program that adopts antibiotic stewardship protocols. Adult patients who accessed a single direct-to-consumer telemedicine center (Jan/2019–Feb/2020) were retrospectively enrolled. Diseases amenable to antimicrobial treatment were classified under five diagnostic groups: upper respiratory tract infection (URI), acute pharyngotonsillitis (PT), acute sinusitis (AS), urinary tract infection (UTI), and acute diarrhea (AD). Physicians were trained on and advised to strictly follow the current guideline recommendations supported by institutional antibiotic stewardship protocols, readily available online during consultations. We analyzed the antibiotic prescription rate among patients, referral rate, and antibiotic class through descriptive statistics. A total of 2328 patients were included in the study. A total of 2085 (89·6%) patients were discharged with usual recommendations, medication (if needed), and instructions about red flags, while 243 (10·4%) were referred to a face-to-face consultation. Among the discharged patients, the antibiotic prescription rates by the diagnostic group were URI — 2·5%, PT — 35·0%, AS — 51·8%, UTI — 91.6%, and AD — 1·6%. In most cases, prescribed antibiotics were in line with institutional stewardship protocols. Low prescription rate of antibiotics can be achieved using antibiotic stewardship protocols at direct-to-consumer telemedicine consultations, showing high adherence to international guidelines. These results reinforce telemedicine as a cost-effective and safe strategy for the initial assessment of acute non-urgent symptoms. [ABSTRACT FROM AUTHOR]