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Antibiotic Prescription Patterns among Pediatric Patients with Pneumonia in Primary Care - A Retrospective Cohort
Jami Aliyah D Salliman1, Leonila D Dans1, Sally Jane Velasco-Aro1
1Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila.
Insights
Pediatric pneumonia antibiotic prescriptions exceed 90%, even with viral causes. Adherence to guidelines was higher in remote than rural primary care settings, highlighting documentation improvement needs.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Primary healthcare research
Background:
- Pediatric pneumonia etiology varies by age, with viral pathogens most common in children aged 1-59 months.
- Antibiotic overuse is a concern in pediatric pneumonia management.
- Local guidelines exist to ensure appropriate antibiotic selection.
Purpose of the Study:
- To determine antibiotic prescription patterns in children aged 1-59 months with community-acquired pneumonia.
- To assess primary care facility adherence to the Philippine Pediatric Community-Acquired Pneumonia Clinical Practice Guidelines (CPG).
- To compare antibiotic use and guideline adherence between rural and remote primary care settings.
Main Methods:
- A descriptive retrospective study analyzed electronic medical records of pediatric patients (1 month-59 months) diagnosed with community-acquired pneumonia.
- Data were collected from two primary care sites (rural and remote) over a one-year period.
- Antibiotic prescribing patterns and adherence to the 2016 Philippine Pediatric Community-Acquired Pneumonia CPG were primary outcomes.
Main Results:
- Antibiotics were prescribed in 96.7% of rural and 94.8% of remote pediatric pneumonia cases.
- Co-amoxiclav was most prescribed in the rural site (26.7%), while amoxicillin dominated in the remote site (51.6%).
- Guideline adherence was significantly lower in the rural site (23.3%) compared to the remote site (55.9%).
Conclusions:
- Primary care physicians frequently prescribe antibiotics for pediatric pneumonia, often irrespective of likely viral etiology.
- Remote primary care settings demonstrated higher adherence to recommended antibiotic guidelines than rural settings.
- Electronic medical record utilization for quality monitoring is crucial for improving pediatric patient outcomes and safety.
Background And Objectives:
The etiology of pneumonia in the pediatric population varies by age group. Among patients one month to 59 months old, viral pathogens are the most common cause of lower respiratory infections. The study aims to determine the frequency distribution of antibiotic prescription among patients one month to 59 months old and to determine the adherence of primary care facilities to local guidelines with recommended antibiotics.
Methods:
A descriptive retrospective study using electronic medical records was conducted at two primary care sites. Patients aged 1 month to 59 months old seeking consult via telemedicine or face-to-face diagnosed with community acquired pneumonia from April 2019-March 2020 in the rural facility and May 2019-April 2020 in the remote facility were included in the study. The primary outcome was to determine the patterns of antibiotic use in pneumonia in remote and rural areas and adherence to the recommended antibiotics by the 2016 Philippine Academy of Pediatric Pulmonologists pediatric community-acquired pneumonia clinical practice guidelines (CPG).
Results:
There were 30 pediatric patients diagnosed with pneumonia in the rural facility and 213 in the remote facility. Of these patients with pneumonia, 96.7% and 94.8% were prescribed antibiotics in the rural and remote sites, respectively. The most commonly prescribed antibiotic in the rural facility was co-amoxiclav (26.7%), while amoxicillin (51.6%) was the most common in the remote facility. Adherence to the CPG in the rural site was lower at 23.3% (n=8/30) compared to the remote site which was 55.9% (n=119/213).
Conclusion:
Primary care physicians prescribed antibiotics in over 90% of the time upon the diagnosis of pneumonia in children aged one month to 59 months old, despite viral pneumonia being the more common in primary care setting. Adherence to recommended antibiotics was higher in the remote setting than in the rural setting. Use of EMR to monitor quality of care can improve patient outcomes and safety, pointing out the importance of improving the quality of documentation in the study sites.
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