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Войти в исследования BMC infectious diseases · 2026
Audit of antibiotic prescribing practices for pediatric pneumonia in the outpatient department: focus on amoxicillin and azithromycin.
СтатьяНазвание и аннотация: Перевод в очереди
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Ahmed Waqar, Ali Iqrar, Ahmed Sheeraz, Naz Samina, Bashir Bela, Shabbir Zarrish, Khaskheli Muhammad Kashif, Nand Heera, Maitlo Habibullah, Unar Fatimah, Bhanbhro Fareeda
Аннотация
BACKGROUND: Antibiotic overuse in childhood pneumonia contributes significantly to antimicrobial resistance, particularly in low- and middle-income countries (LMICs). This clinical audit evaluated outpatient antibiotic prescribing practices, implemented targeted educational interventions, and assessed improvements in the appropriateness of prescribing.
METHODS: A two-cycle clinical audit was conducted at the Children Hospital, Sukkur (SICHN), Pakistan. Children under 15 years diagnosed with pneumonia by treating clinicians in the outpatient department were included during pre-audit (n = 132) and post-audit (n = 153) phases. The audit focused on patients who received antibiotics, evaluating appropriateness in terms of choice, dose, and duration according to WHO AWaRe and IMNCI guidance. Educational sessions and real-time feedback were provided between audit cycles. Data on demographics, clinical features, antibiotic prescriptions, and follow-up were analyzed.
RESULTS: Overall antibiotic prescribing remained high (116/132 [87.9%] pre-audit vs. 135/153 [88.2%] post-audit). However, prescribing quality improved substantially. Amoxicillin use increased from 26/132 (19.7%) to 119/153 (77.8%), with appropriate prescribing rising from 1/26 (3.8%) to 96/119 (80.7%). Azithromycin use decreased from 66/132 (50.0%) to 5/153 (3.3%), with appropriate use improving from 20/66 (30.3%) to 4/5 (80.0%). Documentation practices improved, although objective diagnostic criteria were inconsistently recorded. Follow-up rates remained low (~ 15%), but most returning patients showed clinical improvement.
CONCLUSION: Structured audit and feedback significantly improved the appropriateness of antibiotic prescribing for children diagnosed with pneumonia in outpatient settings. While overall prescribing rates remained unchanged, a marked shift toward guideline-recommended antibiotic use highlights the effectiveness of stewardship-focused interventions in resource-limited, real-world clinical environments.
CLINICAL TRIAL REGISTRATION: This study was a clinical audit and not an interventional clinical trial.
CLINICAL TRIAL NUMBER: not applicable.
METHODS: A two-cycle clinical audit was conducted at the Children Hospital, Sukkur (SICHN), Pakistan. Children under 15 years diagnosed with pneumonia by treating clinicians in the outpatient department were included during pre-audit (n = 132) and post-audit (n = 153) phases. The audit focused on patients who received antibiotics, evaluating appropriateness in terms of choice, dose, and duration according to WHO AWaRe and IMNCI guidance. Educational sessions and real-time feedback were provided between audit cycles. Data on demographics, clinical features, antibiotic prescriptions, and follow-up were analyzed.
RESULTS: Overall antibiotic prescribing remained high (116/132 [87.9%] pre-audit vs. 135/153 [88.2%] post-audit). However, prescribing quality improved substantially. Amoxicillin use increased from 26/132 (19.7%) to 119/153 (77.8%), with appropriate prescribing rising from 1/26 (3.8%) to 96/119 (80.7%). Azithromycin use decreased from 66/132 (50.0%) to 5/153 (3.3%), with appropriate use improving from 20/66 (30.3%) to 4/5 (80.0%). Documentation practices improved, although objective diagnostic criteria were inconsistently recorded. Follow-up rates remained low (~ 15%), but most returning patients showed clinical improvement.
CONCLUSION: Structured audit and feedback significantly improved the appropriateness of antibiotic prescribing for children diagnosed with pneumonia in outpatient settings. While overall prescribing rates remained unchanged, a marked shift toward guideline-recommended antibiotic use highlights the effectiveness of stewardship-focused interventions in resource-limited, real-world clinical environments.
CLINICAL TRIAL REGISTRATION: This study was a clinical audit and not an interventional clinical trial.
CLINICAL TRIAL NUMBER: not applicable.