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BackgroundThere has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. ObjectiveThis study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. MethodsSearches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases’ inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations). ResultsIn total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations. ConclusionsThere is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.

The gut microbiota plays a crucial role in host physiology and the disruption of host-microbiota relationships caused by environmental stressors can impact host growth and survival. In this study, we used Daphnia galeata as a model organism to investigate the interactive effects of fish kairomones on the life-history traits and gut microbiota alterations of D. galeata, as well as the relationship between life-history traits and gut microbiota composition. The presence of fish kairomones enhanced fecundity, decreased growth, and altered gut microbiota, with significant changes in alpha diversity but not in beta diversity in the genotype KB5 of D. galeata. Statistical analysis revealed that the relative abundance of the Pseudomonadaceae family significantly increased upon exposure to fish kairomone, while the relative abundance of the Comamonadaceae family significantly decreased. The decreased growth in genotype KB5 may be associated with a significant increase in Pseudomonas, a member of the family Pseudomonadaceae, which is generally deficient in essential fatty acids, potentially negatively impacting growth. Meanwhile, it is speculated that the significant decrease in Limnohabitans belonging to the Comamonadaceae family is associated with the reduction of body size and increased fecundity of KB5 when exposed to fish kairomones. Furthermore, the genus Candidatus Protochlamydia was observed only under the fi sh kairomones-treated condition. These data suggest that variations in host life-history traits related to reproduction and growth are potentially associated with the relative abundance or presence of these microbial genera. Our research findings provide valuable insights into understanding the impact of biotic stress on the interaction between hosts and microbiota. [ABSTRACT FROM AUTHOR]