Related Experiment Videos

Outpatient antibiotic prescribing for acute respiratory infections in children: an observational study in Nepal

Suraj Bhattarai1,2, Ram Hari Chapagain3,4, Rabin Thami1

  • 1Department of Clinical Research, Global Health Research and Medical Interventions Institute, Kathmandu 44600, Nepal.

International Health
|June 8, 2026
PubMed

Insights

Antibiotic prescribing for childhood acute respiratory infections (ARI) in Nepal is frequently inappropriate. Over half of decisions and over 80% of prescriptions were incorrect, highlighting a need for antibiotic stewardship programs.

Area of Science:

  • Pediatric Infectious Diseases
  • Antimicrobial Stewardship
  • Global Health

Background:

  • Diagnostic challenges in low- and middle-income countries significantly influence antibiotic prescribing for pediatric acute respiratory infections (ARI).
  • Inappropriate antibiotic use contributes to the growing burden of antimicrobial resistance globally.
  • This study investigated antibiotic prescribing practices for pediatric ARI in outpatient settings in Nepal, comparing public and private healthcare facilities.

Purpose of the Study:

  • To assess and compare antibiotic use practices for childhood acute respiratory infections (ARI) in public versus private outpatient facilities in Nepal.
  • To identify the appropriateness of antibiotic prescribing decisions and the selection of antibiotics for pediatric ARI cases.
  • To provide data for the development of targeted antibiotic stewardship programs.

Main Methods:

  • A cross-sectional observational study was conducted in one public and one private pediatric hospital in Nepal from January to July 2022.
  • The World Health Organization's ARI case management checklist was adapted and used to observe 104 randomly selected, disguised doctor-patient consultations.
  • Descriptive statistics were employed to analyze and compare antibiotic prescribing practices between the two types of facilities.

Main Results:

  • While 76% of ARI diagnoses adhered to national protocols (better in private facilities, p=0.039), antibiotics were prescribed in 64% of cases, with no significant difference between facility types (p=0.838).
  • Alarmingly, only 9% of antibiotic prescriptions utilized the recommended first-line drug (amoxicillin).
  • Provider decisions were inappropriate in 54% of cases, and among those prescribed antibiotics, 81% received the incorrect one.

Conclusions:

  • High rates of inappropriate antibiotic decisions and prescriptions for pediatric ARI were observed in both public and private healthcare settings in Nepal.
  • The findings underscore a critical need for further research to determine the full scope of the problem.
  • There is a clear necessity for implementing and evaluating antibiotic stewardship programs specifically targeting healthcare providers in these settings.
Abstract

Keywords:
acute respiratory infectionsantimicrobial resistanceoutpatient antibiotic usepaediatric antibiotic stewardshippublic vs private

Related Concept Videos

Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Clinical Significance of Antibiotic Resistance01:25

Clinical Significance of Antibiotic Resistance

Methicillin-resistant Staphylococcus aureus (MRSA) presents a critical public health threat, arising from its capacity to resist β-lactam antibiotics due to acquisition of the mecA gene within the staphylococcal cassette chromosome mec (SCCmec). This gene encodes penicillin-binding protein 2a (PBP2a), which impairs binding efficacy of methicillin and other β-lactams. MRSA has evolved into distinct clonal lineages impacting humans and animals alike, reinforcing its significance within the One...
Antibiotic Selection00:57

Antibiotic Selection

Overview
Acute Pyelonephritis I: Introduction01:27

Acute Pyelonephritis I: Introduction

Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such as Proteus,...
Tonsillitis II: Management01:26

Tonsillitis II: Management

This lesson will focus on the different treatment options for managing tonsillitis, which typically depend on the cause and severity.