Antibiotic use Evaluation in Hospitalized Pediatric Patients with Respiratory Tract Infections: A Retrospective Chart
Amir Ali Mahboobipour1, Shadi Baniasadi2, Elahe Saberi Shahrebabaki2
1School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Antibiotic use for pediatric respiratory infections shows low guideline adherence, particularly with azithromycin. Optimizing antibiotic therapy is crucial to combat resistance and reduce costs in hospitalized children.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Clinical Pharmacy
Background:
- Respiratory tract infections (RTIs) are a leading cause of antibiotic prescriptions in hospitalized children.
- Inappropriate antibiotic use contributes to multidrug-resistant organisms and elevated healthcare expenses.
Purpose of the Study:
- To evaluate antibiotic prescribing patterns for pediatric patients with RTIs.
- To assess adherence to international guidelines for antibiotic therapy in this population.
Main Methods:
- Retrospective review of medical charts for 279 pediatric patients in a tertiary respiratory center.
- Data collected included demographics, diagnoses (pneumonia, cystic fibrosis, bronchitis), and antibiotic details (agent, dose, frequency).
- Antibiotic appropriateness was assessed against established international guidelines.
Main Results:
- Pneumonia was the most frequent diagnosis (38%).
- Guideline adherence varied significantly by antibiotic: ceftriaxone (85.3%), clindamycin (47%), and azithromycin (23.3%).
- Inappropriate dosing was the primary reason for non-adherence; overall guideline adherence was 27.6%. Cystic fibrosis and azithromycin use predicted non-adherence.
Conclusions:
- This study identified suboptimal adherence to antibiotic guidelines for pediatric RTIs in the studied center.
- While many therapies were logical, targeted interventions are needed to improve antibiotic stewardship.
- Addressing factors like restricted definitions of optimal therapy may enhance antibiotic use.
Introduction:
Respiratory tract infections (RTIs) are a common cause of antibiotic usage in hospitalized pediatric patients. Inappropriate use of antibiotics may lead to the emergence of multidrug-resistant microorganisms and increased treatment costs.
Objective:
This study was designed to assess antibiotic usage in hospitalized pediatric patients with RTIs.
Methods:
Medical charts of the patients admitted to the pediatric ward (PW) and pediatric intensive care unit (PICU) of a tertiary respiratory center were reviewed. Patients' demographic and clinical data, including gender, age, weight, history of allergy, length of hospital stay, clinical diagnosis, and prescribed antibiotics (indication, dose, and frequency of administration) were collected. The appropriateness of antibiotic usage was evaluated in each patient according to international guidelines.
Results:
Two hundred seventy-nine hospitalized patients were included in the study. The most common reason for hospitalization was pneumonia (38%), followed by cystic fibrosis (20.1%) and bronchitis (5%). The most commonly used antimicrobial agents were ceftriaxone, azithromycin, and clindamycin which guideline adherence for their usage was 85.3%, 23.3%, and 47%; respectively. Inappropriate dose selection was the main reason for non-adherence to the guidelines. The adherence rate to RTIs' guidelines (considering all parameters for each patient) was 27.6%. Multivariate logistic regression analysis demonstrated CF and prescription of azithromycin are predictors of guideline non-adherence.
Conclusion:
We found relatively low adherence to international guidelines in our center that could be related to restricted definitions of optimal antibiotic therapy. Despite most patients received logical antimicrobial therapy, actions should be taken into account to reach optimal antibiotic usage.
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