Audit of antibiotic prescribing practices for pediatric pneumonia in the outpatient department: focus on amoxicillin and azithromycin.

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.