ANTIBIOTIC PRESCRIBING PATTERNS AND TREATMENT OUTCOMES IN PEDIATRIC PNEUMONIA: EVIDENCE FOR ANTIMICROBIAL STEWARDSHIP FROM TERTIARY CARE HOSPITALS IN PESHAWAR, PAKISTAN

Abstract

Background: Rational antibiotic selection is central to the safe and effective management of pediatric pneumonia, particularly against a backdrop of rising antimicrobial resistance (AMR) in South Asia.

Objective: To characterize antibiotic prescribing patterns for pediatric pneumonia in tertiary care hospitals in Peshawar, Pakistan, and to evaluate whether treatment outcome differed by antibiotic agent, as a marker of guideline-concordant, stewardship-consistent prescribing.

Methods: A cross-sectional, retrospective chart-review study of 180 hospitalized paediatric pneumonia patients (2 months–12 years) was conducted at participating tertiary care hospitals using non-probability convenience sampling. Primary antibiotic therapy and treatment outcome (recovered, improved, ICU transfer, death) were extracted from structured medical records. The association between antibiotic agent and outcome was tested using chi-square analysis, one-way ANOVA, and linear regression in SPSS. Results: Five antibiotic regimens accounted for the entire cohort: Ampicillin + Gentamicin (21.7%), Azithromycin (21.1%), Amoxicillin (20.6%), Cefotaxime (20.6%), and Ceftriaxone (16.1%). Favourable outcome (recovery or clinical improvement) ranged from 67.6% with Amoxicillin to 89.5% with Azithromycin and 89.2% with Cefotaxime, with Ampicillin + Gentamicin (84.6%) and Ceftriaxone (79.3%) intermediate. Despite this numeric spread, neither one-way ANOVA (F = 2.241, p = 0.067), chi-square association (χ² = 18.105, df = 12, p = 0.113), nor linear regression (B = 0.073, β = 0.107, p = 0.153; R² = 0.011) demonstrated a statistically significant relationship between antibiotic choice and treatment outcome. Overall, 62.2% of patients recovered and 20.0% improved, while 10.6% required ICU transfer and 7.2% died. Conclusion: Antibiotic prescribing at the participating hospitals followed established first- and second-line regimens for pediatric pneumonia, and no antibiotic agent was associated with significantly worse outcomes - evidence consistent with broadly guideline-concordant, stewardship-appropriate practice. Continued adherence to evidence-based antibiotic protocols, rather than empirical escalation to broader-spectrum agents, should be reinforced to sustain favourable outcomes while limiting resistance pressure.

Keywords: pediatric pneumonia; antibiotic therapy; antimicrobial stewardship; treatment outcome; prescribing patterns; tertiary care; Pakistan