Assessment Of Antibiotic Use and Prescribing Practices in Hospitalized Pediatric Patients: A Retrospective, Observational Study.

Abstract

Background: Antibiotics are frequently prescribed in hospitalized pediatric patients, particularly when serious bacterial infection is suspected. However, inappropriate antibiotic selection, prolonged duration, and excessive use of broad-spectrum agents may contribute to antimicrobial resistance. This study assessed antibiotic utilization and prescribing practices among hospitalized pediatric patients. Methods: A retrospective observational study was conducted over a period of six months, from January to June 2026 in the Department of Pediatrics at Autonomous State Medical College & Allied Pt. Ram Prasad Bismil Hospital, Shahjahanpur. Pin-24001 (U.P), Collaboration with Department of Pharmacology Autonomous State Medical College, Kanpur Dehat, (U.P), over a period of Six Months. A total of 143 eligible pediatric patients were initially enrolled, of whom 3 were excluded due to incomplete data or loss to follow-up, resulting in 140 patients for final analysis. Data regarding demographic characteristics, diagnosis, antibiotics prescribed, dose, frequency, route, duration, treatment approach, and laboratory investigations were collected using a standardized data collection form. Antibiotic prescribing was assessed for appropriateness and classified according to the WHO AWaRe framework. Descriptive statistics and chi-square tests were used for analysis, with p<0.05 considered statistically significant. Results: Among 140 patients, 58.6% were male and 41.4% were female. Children aged 6–12 years constituted the largest age group (42.9%). Respiratory tract infections were the most common diagnosis (27.1%), followed by acute gastroenteritis (17.1%) and pneumonia (15.7%). Ceftriaxone was the most frequently prescribed antibiotic (30.0%), followed by amoxicillin–clavulanic acid (17.1%) and cefotaxime (12.9%). Intravenous administration was predominant (75.0%), while monotherapy accounted for 62.9% and empirical therapy for 73.6% of prescriptions (p<0.001). The mean duration of antibiotic therapy was 6.4±2.3 days. According to the WHO AWaRe classification, Watch-group antibiotics accounted for 64.3% of prescriptions, followed by Access-group antibiotics (30.0%) and Reserve-group antibiotics (3.6%). Overall, 73.6% of prescriptions were considered appropriate, whereas 26.4% were inappropriate. Appropriateness was highest for route of administration (89.3%) and lowest for duration of therapy (72.1%). Conclusion: The study demonstrated substantial use of broad-spectrum and Watch-group antibiotics among hospitalized pediatric patients, with empirical therapy being the predominant approach. Although most prescriptions were considered appropriate, considerable scope for improvement was identified, particularly regarding antibiotic duration and selection. Strengthening antimicrobial stewardship, regular prescription auditing, microbiological investigation, timely reassessment of empirical therapy, and adherence to WHO AWaRe recommendations may promote rational antibiotic use and reduce unnecessary antimicrobial exposure and antimicrobial resistance.