Antibiotic use among young, hospitalized children in Jordan, 2010-2023

Inappropriate antibiotic use drives antimicrobial resistance, a global health threat causing increased morbidity and mortality. Understanding antibiotic practices in low-resource settings is essential to identify intervention targets. This study investigates antibiotic prescription practices in Amman, Jordan. We conducted three prospective viral surveillance studies at the largest public hospital in Amman, Jordan (2010-2013, 2020, and 2023) and included children <2 years old hospitalized with fever or respiratory symptoms. The data collected included antibiotic use and the results of blood, urine, and cerebrospinal fluid (CSF) cultures performed. We classified antibiotics according to the 2023 WHO AWaRe system. Nasal or throat samples were tested in a research laboratory for respiratory viruses using RT-PCR. The median age of the 4,724 children included was 3.5 months (IQR, 1.6-8.4). A clinical blood, urine, or CSF sample was collected from 2,565/4,712 children (54.4%), 356 (13.9%) of whom tested positive. During hospitalization, 4,375 children (92.6%) received at least one antibiotic, and 4,245 (97.0%) received at least one antibiotic from the Watch group. One or more respiratory viruses were detected in 3,911 children (82.8%). Providers ordered cultures most often for children 0-2 months old (n = 1,579 [73.5%]) and those with an admission diagnosis of rule-out sepsis (n = 1,164 [95.4%]). Antibiotic use and testing practices were consistent across study years, age groups, and admission diagnoses. In conclusion, widespread antibiotic use despite the preponderance of viral infections highlights a significant discrepancy in aligning treatment practices with disease etiology. Strengthening diagnostic and preventive capabilities in low-resource settings is crucial to combat antimicrobial resistance.

In this study of 4,724 children under 2 years old hospitalized in the largest public hospital in Jordan between 2010 and 2023, 92.6% received antibiotics despite 82.8% testing positive for respiratory viruses and only 13.9% of collected cultures suggesting bacterial infection. Despite the predominance of viral infections, the widespread use of antibiotics, particularly from the World Health Organization Watch group, highlights the need for improved antibiotic stewardship and diagnostic capabilities in Jordan.