Trends in Antibiotic Use for Pediatric Patients With Pneumonia: A Nationwide Analysis in South Korea (2016-2023)

Pneumonia is a leading cause of antibiotic use for children. This study aimed to assess nationwide antibiotic prescribing patterns for pediatric pneumonia in South Korea between 2016 and 2023, a period encompassing both epidemic and nonepidemic periods of Mycoplasma pneumoniae pneumonia (MPP).

Using national claims data from the Health Insurance Review and Assessment Service, we analyzed antibiotic prescriptions for patients under 18 years diagnosed with bacterial pneumonia (International Classification of Diseases, 10th Revision codes; viral pneumonia was excluded). Antibiotic use was measured in days of therapy per 1000 patient-days (inpatients) or per 1000 patients (outpatients).

Among 8.7 million inpatient days and 3.5 million outpatient visits, the 2-4 years group accounted for the highest burden (497.1 inpatient days and 161.6 outpatient visits per 1000 population). Macrolides were the most prescribed class in both inpatients [805.1 days of therapy (DOT)/1000 patient-days] and outpatients (4898.0 DOT/1000 patients), except in infants, where third-generation cephalosporins predominated. Use of third-generation cephalosporins increased sharply from 2022 and became the most prescribed class in 2023. Tertiary hospitals had higher use of tetracyclines (26.8 DOT/1000 patient-days) and quinolones but lower use of beta-lactams than other facility types. Antibiotic prescribing peaked in the fourth quarter of each year.

Among children in South Korea diagnosed with bacterial pneumonia, macrolides were most frequently prescribed, and prescriptions for third-generation cephalosporins showed an increasing trend. These findings underscore challenges in antimicrobial stewardship and need for strengthened nationwide antimicrobial stewardship policies for pediatric pneumonia tailored to age, setting, and seasonal trends.