Drug utilization patterns and drug-related problems in pediatric bacterial meningitis: A prospective observational study from a tertiary care hospital in Pakistan

Abstract

Background: Bacterial meningitis is a neurological emergency associated with substantial mortality and long-term disability in children, particularly in low- and middle-income countries where ward-based clinical pharmacy oversight is scarce. The multidrug regimens required for its management create ample opportunity for drug-related problems (DRPs). Objective: To evaluate the rationality of pharmacotherapy, characterize DRPs and describe antimicrobial prescribing patterns in children hospitalized with bacterial meningitis at a tertiary care hospital. Methods: A prospective, observational, single-centre study was undertaken over 90 days in the pediatric ward of Lady Reading Hospital, Peshawar, Pakistan. Twenty consecutive children aged 0–12 years with clinically and/or laboratory-confirmed bacterial meningitis were assessed for demographic and clinical characteristics, prescribed medicines and DRPs (drug–drug interactions, contraindications, adverse drug reactions, dosing and route errors) using a structured proforma. Prescriptions were audited against standard pediatric meningitis treatment guidelines. Data were summarized descriptively and reported in accordance with the STROBE statement. Results: Fourteen children (70%) were male and 8 (40%) were infants aged under 2 years. Guideline-concordant therapy was documented in 17 patients (85%). Ceftriaxone was the most frequently prescribed antibiotic (11; 55%), followed by meropenem (5; 25%), ampicillin (4; 20%) and ciprofloxacin (2; 10%); vancomycin (12; 60%) and aciclovir (5; 25%) were used adjunctively, and dexamethasone in 19 (95%). DRPs were identified in 5 patients (25%): drug–drug interactions in 2 (aciclovir–vancomycin; phenytoin–dexamethasone), adverse drug reactions in 2 and a contraindication in 1. Comorbidity was present in 16 (80%), most commonly epilepsy (13; 65%). No deaths occurred and length of stay was 5–9 days. Conclusion: Although most children received rational pharmacotherapy, DRPs affected one quarter of patients. These findings underscore the value of clinical pharmacy services, standardized treatment protocols and systematic interaction screening in pediatric wards in resource-limited settings.