Audit of Antibiotic Prescribing Practices for Pediatric Pneumonia in the Outpatient Department: Focus on Amoxicillin and Azithromycin

Background Antibiotic overuse in childhood pneumonia drives antimicrobial resistance, especially in LMICs. This audit evaluated outpatient prescribing patterns, implemented targeted interventions, and assessed post-audit improvements in guideline-based prescribing. Methods A two-cycle clinical audit was conducted at the Children’s Hospital, Sukkur, Pakistan. Children under 15 years presenting with cough and/or difficulty breathing and age-specific tachypnea were evaluated during pre-audit (n = 132) and post-audit (n = 153) cycles. Educational sessions emphasized WHO AWaRe and IMNCI guidelines recommending amoxicillin as first-line therapy. Data were collected on demographics, clinical features, antibiotic type, dose, and appropriateness. Results Overall antibiotic prescribing remained high (116/132 [87.9%] pre-audit vs 135/153 [88.2%] post-audit). Appropriateness improved markedly: amoxicillin prescriptions rose from 26/132 (19.7%) to 119/153 (77.8%), with guideline-concordant use increasing from 5/132 (3.8%) to 96/153 (62.7%). Azithromycin use fell from 66/132 (50.0%) to 5/153 (3.3%), with guideline-concordant use increasing from 20/66 (30.3%) to 4/5 (80.0%). Clinical documentation and adherence to pneumonia criteria improved significantly. Follow-up rates remained low (15%), though most returning patients demonstrated clinical improvement. Conclusion Structured audit and feedback markedly improved guideline-adherent antibiotic prescribing for pediatric pneumonia, increasing appropriate amoxicillin use and reducing inappropriate macrolide prescriptions. Short, focused interventions in LMIC outpatient settings can effectively improve antimicrobial stewardship.