Antibiotic use Appropriateness, Clinical Outcomes, and their Determinant factors among Pediatric Pneumonia Patients in Selected Comprehensive Specialized hospitals in Northwest Amhara, 2024: A Prospective Follow-up study

Abstract

Introduction: Pneumonia remains a leading cause of morbidity and mortality among children in low- and middle-income countries. The proper use of antibiotics is the gold standard in the treatment of bacterial pneumonia. Clinical outcomes in pediatric pneumonia encompass a spectrum ranging from complete recovery to adverse events. Objectives: This study aimed to assess the appropriateness of antibiotic use and identify determinants of poor clinical outcomes in pediatric pneumonia patients in selected hospitals in Northwest Amhara, in 2024. Methods: A prospective follow-up, multicenter study was conducted in three hospitals (Gondar, Debre Markos, and Bahir Dar) from June 2024 to September 2024. 360 pediatric patients with pneumonia were included. The collected data was analyzed using SPSS version 26. Results were presented in the form of text, tables, and graphs. Multivariable logistic regression was used to examine the association between inappropriate antibiotic use, poor outcomes, and determinants. The variable with a P-value less than 0.05 in the multivariable analysis was considered significantly associated with inappropriate antibiotic use and poor clinical outcomes. Result: From a total of 360 patients included, 138 (38.1%) (95% CI: 33.3–43.6%) used inappropriate antibiotics with independent predictors of prescriptions by pediatricians (p=0.025, AOR=5.008(1.228-20.425) and pediatric residents (p=0.000, AOR=4.076(2.492-6.667) and comorbidity (p=0.027, AOR=1.717(1.062-2.777), while 11.1% of the patients experienced poor clinical outcomes. Independent predictors of poor outcome were not vaccinated (p =0.004, AOR=3.873(1.534-9.777)), inappropriate antibiotic use (p =0.001, AOR=4.740(1.940-11.581)), patients with length of hospital stay > 7days (P =0.000, AOR=5.792(2.326-14.422)), patients with grunting (P =0.012 AOR=3.618(1.332-9.826)), and patients with decreased SPO2 (P =0.024, AOR=3.769(1.195-11.890)). Conclusion: Inappropriate antibiotic use remains a major concern in managing pediatric pneumonia, contributing to poor clinical outcomes. Prescriptions by pediatricians and pediatric residents and comorbidity were associated with inappropriate antibiotic use while, not being vaccinated, prolonged hospital stays, grunting, inappropriate antibiotic use, and decreased oxygen XII saturation were independent predictors of poor outcomes and hence practitioners should never contempt these factors to give priority for those cases coming with them