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Telemedicine (i.e. delivering clinical care at a distance with the use of technology) can improve the management of current infections and avoid antibiotic misuse. Susanna et al. have recently published three studies on telemedicine for healthcare systems in pediatric systems, focusing on the territorial level of chronic diseases and the need for information and training for pediatricians and parents to reduce medical devices. They emphasized that using telemedicine allows for the compilation of various data with a clear indication of conditions for which in-person examination is limited. Currently, in-person examinations are discouraged for patients below three months with a fever, diarrhea or paleness and for patients of any age with respiratory distress, with non-compensating underlying disease or a cough for more than seven days. There are certain chronic conditions where antibiotics are frequently prescribed that can have a negative outcome without appropriate monitoring. Susanna believes that telemedicine used in conjunction with AI can highlight the most crucial problems and subsequently proceed with an appropriate antimicrobial prescription.

In their studies, Susanne et al. presented their experience in Covid management using telemedicine. They were able to avoid antibiotic use and identify some viral infections that were concomitant to the first wave of Covid circulation. In addition, the Mayo Clinic in the U.S.A. used artificial intelligence for Covid-19 diagnosis. These examples show that the use of telemedicine, together with artificial intelligence can improve the possibility of the appropriate management of viral infections.

Furthermore, telehealth technology in Italy is proving useful for home monitoring and the evaluation of adherence to different therapies in cystic fibrosis patients. A survey found that 60% of patients in the Parma center for cystic fibrosis were satisfied with telehealth visits and were able to perform pulmonary function testing at home, reducing the number of visits at the treatment centre. There are also wearable technologies in addition to spirometry and the possibility of monitoring oxygen saturation. With these wearables, it is possible to monitor treatment adherence. Moreover, telemedicine is being used to improve the diagnosis of Aspergillus infection, which can be difficult to diagnose because it can either be a case of hypersensitivity or an infection that needs to be treated quickly in order to have a positive outcome. In the case of Aspergillus infection, it is important to use artificial intelligence in the radiologic follow-up of these patients. Thus, the use of telemedicine has the potential to significantly change patients’ survival by monitoring adherence to prescribed therapies, improving physical exercise, access to care, and patient education.

Lastly, Susanna believes that artificial intelligence can be useful in antimicrobial stewardship programmes in the general population, as it can monitor prescriptions in relation to guidelines and also improve the medical approach after considering the results of, for example, rapid diagnostic tests. Furthermore, the key role of artificial intelligence is in the improvement of the quality of care and the prevention of the emergence of antibiotic resistance in patients. Additionally, in the approach to parents, the use of artificial intelligence can help monitor antimicrobial prescriptions, help with appropriate disease management and education of caregivers on when antibiotics are recommended. Moreover, the possibility of developing new antimicrobial peptides or discovering new antibiotics is another very attractive approach to using AI.

Prof. Susanna Esposito Full Professor of Pediatrics, Director of the Specialty School of Pediatrics at the School of Medicine and Director of the Pediatric Clinic of the University of Parma.

Written by: Christine de Zwart