Antibiotic use in children hospitalised with pneumonia in Central Vietnam
Phuong Tk Nguyen1,2, Hoang T Tran3, Dominic A Fitzgerald2,4
1Department of Respirology, Da Nang Hospital for Women and Children, Da Nang, Vietnam thng5150@uni.sydney.edu.au.
Insights
Antibiotic overuse in hospitalized children with pneumonia in Vietnam is high, contributing significantly to healthcare costs. Reducing unnecessary hospitalizations and optimizing antibiotic treatment pathways can lower costs and improve outcomes.
Area of Science:
- Pediatric infectious diseases
- Health economics
- Antibiotic stewardship
Background:
- Antibiotic use in children with respiratory infections in Vietnam is excessive, but data on hospitalized children are limited.
- This study assesses antibiotic use and associated healthcare costs in children hospitalized with pneumonia in central Vietnam.
Purpose of the Study:
- To evaluate antibiotic prescribing patterns and direct healthcare costs for pediatric pneumonia hospitalizations.
- To identify areas for cost reduction and improved antibiotic stewardship in this population.
Main Methods:
- A prospective descriptive study was conducted over one year at the Da Nang Hospital for Women and Children.
- Included were children under 5 years old admitted with a primary diagnosis of pneumonia.
Main Results:
- Nearly all hospitalized children (98.0%) received antibiotics, with 12.3% of non-severe pneumonia cases receiving intravenous antibiotics without clear indication.
- Intravenous antibiotic use was high even in non-severe pneumonia cases (12.3%), and early step-down to oral antibiotics was infrequent (19.3%).
- Hospitalization for oral antibiotics in non-severe pneumonia was a major cost driver (US$78.9/patient), accounting for 54.0% of total costs, with unnecessary IV antibiotic use adding 23.2% to costs.
Conclusions:
- Unnecessary hospitalizations and delayed intravenous to oral antibiotic step-down contribute to high healthcare costs and morbidity in pediatric pneumonia.
- Interventions focusing on judicious hospitalization and optimized antibiotic treatment strategies are crucial for cost containment and improved patient outcomes in Vietnam.
Background And Objectives:
Excessive use of antibiotics has been noted in children with respiratory tract infections in Vietnam, but antibiotic use in hospitalised children is poorly documented. Antibiotic use and direct healthcare costs in children hospitalised with pneumonia in central Vietnam were assessed.
Methods:
A prospective descriptive study of children under 5 years old admitted with a primary admission diagnosis of 'pneumonia' to the Da Nang Hospital for Women and Children over 1 year.
Results:
Of 2911 children hospitalised with pneumonia, 2735 (94.0%) were classified as 'non-severe' pneumonia by the admitting physician. In total, 2853 (98.0%) children received antibiotics. Intravenous antibiotics were given to 336 (12.3%) children with 'non-severe' and 157/176 (89.2%) children with 'severe' pneumonia; those with 'non-severe' pneumonia accounted for 68.2% (336/493) of intravenous antibiotics given. Only 19.3% (95/493) of children on intravenous antibiotics were stepped down to an oral antibiotic. Cefuroxime was the preferred oral agent, and ceftriaxone was the preferred injectable agent. Hospital admission for oral antibiotics in 'non-severe' pneumonia was a major cost driver, with an average direct cost of US$78.9 per patient, accounting for 54.0% of the total hospitalisation cost in the study cohort. In addition, 336 (12.3%) children with non-severe pneumonia received intravenous antibiotics without indication, accounting for a further 23.2% of hospitalisation costs.
Conclusion:
Limiting unnecessary hospitalisation and considering early intravenous to oral step down antibiotic will reduce direct health system costs and morbidity in children with respiratory tract infections in Vietnam.
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