The Four Moments of Antibiotic Decision Making in Telemedicine

Assess whether you can adequately address the patient’s complaint through a telemedicine visit.

Before prescribing antibiotics, ensure that the patient has signs and symptoms suggesting a bacterial infection. Many patients have symptoms that are not consistent with an infection or are consistent with a viral infection; antibiotics should not be prescribed in these cases.

Consider if any diagnostic tests are needed that may help determine if the patient has a bacterial infection or which antibiotic might be indicated.

If an antibiotic is indicated, prescribe an antibiotic with the narrowest spectrum of activity needed to treat the most likely bacteria present that has the fewest side effects. Always use the shortest effective antibiotic duration for the infectious process you are treating.

Whether or not an antibiotic is prescribed, offer suggestions to patients to assist with symptomatic relief.

Before the end of the telemedicine visit, ensure that the patient knows when they may need to contact the practice, either with concerns related to the symptoms, the infection, or the antibiotic, and when they need to schedule a followup appointment.