Background Asynchronous virtual patient care is increasingly used; however, the effectiveness of virtually delivering guideline-concordant care in conjunction with antibiotic stewardship initiatives remains uncertain. We developed a bundled stewardship intervention aimed at improving antibiotic use in E-visits for upper respiratory tract infections (URTIs). Methods In this pre-post study, adult patients who completed E-visits for “cough,” “flu,” or “sinus symptoms” at Michigan Medicine 1/1/2018 through 9/30/2020 were included. Patient demographics, diagnoses, and antibiotic details were collected. The multi-faceted intervention occurred over 6 months. Segmented linear regression was performed to estimate the effect of the intervention on appropriate antibiotic use for URTI diagnosis (defined as no antibiotic prescribed) and sinusitis (defined as guideline-concordant antibiotic selection and duration). Regression lines were fit to data before (1/2019) and after (5/2019) the bundled intervention. Results 5151 E-visits were included. The intervention decreased the number of visits for flu, cough, or sinus symptoms prescribed antibiotics from 43.2% to 28.9% (p<0.001). The guideline concordance of antibiotic prescriptions improved following the intervention: first-line amoxicillin/clavulanate rose from 37.9% of prescriptions to 66.1% of prescriptions (p<0.001), second-line doxycycline rose from 13.8% to 22.7% (p<0.001) and median duration of antibiotics decreased from 10 days to 5 days (p<0.001). Conclusion A multifaceted stewardship bundle for E-visits involving both changes in the EMR and audit and feedback improved guideline-concordant antibiotic use for URTIs. This approach can aid stewardship efforts in the ambulatory care setting with regards to telemedicine.