Antibiotic Use in Pediatric Care in Ghana: A Call to Action for Stewardship in This Population

Background/ Objectives: Antibiotic use is common among hospitalized pediatric patients. However, inappropriate use, including appreciable use of Watch antibiotics, can contribute to antimicrobial resistance, adverse events and increased healthcare costs. Consequently, there is a need to continually assess their usage among this vulnerable population. This was the objective behind this study. Methods: The medical records of all pediatric patients (under 12 years) admitted and treated with antibiotics at a Ghanaian Teaching Hospital between January 2022 and March 2022 were extracted from the hospital’s electronic database. The prevalence and appropriateness of antibiotic use was based on antibiotic choices compared with current guidelines. Influencing factors were also assessed. Results: Of the 410 admitted patients, 319 (77.80%) received at least one antibiotic. The majority (68.65%, n=219/319) were between 0-2 years and males (54.55%, n=174/319). Ceftriaxone was the most commonly prescribed antibiotic (20.69%, n=66/319), and most of the systemic antibiotics used belonged to the WHO Access and Watch groups including a combination of Access and Watch groups (42.90%, n=136/319). Neonatal sepsis (24.14%, n=77/319) and pneumonia (14.42%, n=46/319) were the most common diagnoses treated with antibiotics. Antibiotic appropriateness was 42.32% (n=135/319). Multivariate analysis revealed ceftriaxone prescriptions (aOR=0.12, CI=0.02-0.95, p-value=0.044) and surgical prophylaxis (aOR=0.07, CI=0.01-0.42, p-value=0.004) were associated with reduced antibiotic appropriateness, while a pneumonia diagnosis appreciably increased this (aOR=15.38, CI=3.30-71.62, p-value < 0.001). Conclusion: There was high and suboptimal usage of antibiotics among hospitalized pediatric patients in this leading hospital. Antibiotic appropriateness was influenced by antibiotic type, diagnosis, and surgical prophylaxis. Targeted interventions, including education, are needed to improve antibiotic utilization in this setting in Ghana and subsequently in ambulatory care