Antibiotic Prescribing Practices and Antimicrobial Resistance in Pediatric Pneumonia

Abstract

Background: Antimicrobial resistance (AMR) among pediatric pneumonia patients presents a significant challenge, particularly in low- and middle-income countries such as Pakistan, where empirical antibiotic use is prevalent and stewardship interventions remain limited. Comprehensive knowledge of local prescribing practices, resistance patterns, and treatment outcomes is essential for effective stewardship and enhanced patient care. Objective:  To determine the prevalence and antimicrobial susceptibility patterns of bacterial pathogens isolated from pediatric pneumonia patients and to evaluate antibiotic prescribing practices in a tertiary care hospital. Methodology: This prospective observational study enrolled 423 pediatric patients diagnosed with pneumonia. Data collection included antibiotic prescribing patterns, specimen microbiology, antimicrobial susceptibility, and clinical outcomes. Respiratory specimens underwent bacterial identification and susceptibility testing. Associations among prescribing practices, resistance, and clinical outcomes were analyzed. Results: Nearly all patients (98.3%) received antibiotics, with 59.8% receiving combination therapy and 87.3% treated intravenously. Clinically significant bacteria were isolated from 41.9% of processed specimens. Among these isolates, 68.3% demonstrated resistance to at least one antibiotic, and 34.5% were classified as multidrug-resistant. Streptococcus pneumoniae was the most frequently identified pathogen, exhibiting substantial resistance to ampicillin-cloxacillin and penicillin. Inappropriate initial empirical therapy was observed in 57.2% of culture-positive cases and was associated with increased antibiotic switching and prolonged hospital stays. Conclusion: This pediatric pneumonia cohort showed antibiotic resistance. Improved antimicrobial stewardship, guided by local surveillance data, is urgently required to optimize therapy, mitigate resistance, and improve patient outcomes.