Audit of compliance to recommended antibiotics prescription guidelines in the management of community-acquired pneumonia in a children's outpatient clinic, in Portharcourt, Nigeria

Abstract

Background: The Paediatric Association of Nigeria produced a guideline for managing and diagnosing community-acquired pneumonia. This study aims to assess compliance with the recommended antibiotics prescriptions. Methods: A prospective review of the folders of children who presented with cough symptoms in the children's general outpatient clinic of Rivers State University Teaching Hospital. Their biodata, clinical examination findings, prior antibiotics exposure, and consult outcome were retrieved and analyzed. Results: A total 253 children with a median age of 3 years were studied from June to September 2022. No pneumonia was seen in 128 (50.6%), while 93 (36.8%) had various severity of Pneumonia. Antibiotics had been taken by 55 (21.7%) of the children before presentation. Antibiotics were prescribed in 210 (83.0%) of all the consultations for symptoms of cough. The antibiotic prescription rate for children with No pneumonia was 108 (84.4%), Pneumonia was 77 (88.5%) and severe pneumonia was 5 (83.3%). Cephalosporins were the most common type of antibiotics prescribed for Pneumonia and severe pneumonia at a rate of 52.6% and 57.1% respectively. The overall compliance rate with the PAN recommendations for antibiotic treatment guidelines was 42.5%. Children with No pneumonia significantly had higher odds of being managed with prescriptions that were not in line with the recommendation (OR;25.4, 95% CI:12.2,52.7, p<0.05). The highest type of Noncompliance was prescribing antibiotics where it was not indicated 109 (85.8%). Conclusions: Compliance with PAN recommendations for antibiotics treatment in community-acquired pneumonia is suboptimal. While the production of guidelines is excellent in standardizing health care, more work is needed to ensure these guidelines are utilized.