Antibiotic use appropriateness and its determinant factors among pediatric pneumonia patients in selected comprehensive specialized hospitals in Northwest Amhara, 2024: a prospective follow-up study

Proper use of antibiotics is the gold standard for treating bacterial pneumonia. Inappropriate prescribing leads to poor clinical outcomes and accelerates antibiotic resistance. This study aimed to assess the appropriateness of antibiotic use and identify its determinants in pediatric pneumonia patients in selected hospitals in Northwest Amhara in 2024. This prospective multicenter study was conducted from June to September 2024 at three specialized hospitals in Northwest Ethiopia (Gondar, Debre Markos, and Bahir Dar). Data regarding diagnostic methods, pneumonia classification, and antibiotic regimens were extracted from the medical records of pediatric patients using a validated, structured checklist. The appropriateness of antibiotic use was evaluated against the 2021 Ethiopian National Standard Treatment Guideline and Infectious Diseases Society of America (IDSA) guidelines based on drug selection, dosage, frequency, and duration. Statistical analysis was performed using SPSS version 26. Multivariable logistic regression was employed to identify independent determinants of inappropriate antibiotic use, with statistical significance defined as P < 0.05. Among the 360 included patients (median age 1.5 years; 58.9% male), the majority (74.7%) were aged under five years, and 88.9% were diagnosed with Community-Acquired Pneumonia (CAP). Ceftriaxone was the most commonly prescribed antibiotic overall (38.1%). The prevalence of inappropriate antibiotic use was 38.3% (95% CI: 33.3–43.6%), with incorrect drug selection (42.9%) being the primary reason for inappropriateness. Independent predictors of inappropriate antibiotic use were prescriptions by pediatricians (AOR = 5.008, 95% CI: 1.228–20.425; p = 0.025), pediatric residents (AOR = 4.076, 95% CI: 2.492–6.667; p < 0.001), and the presence of comorbidity (AOR = 1.717, 95% CI: 1.062–2.777; p = 0.027). Inappropriate antibiotic use remains a major concern in managing pediatric pneumonia, contributing to poor clinical outcomes. Prescriptions by pediatricians and pediatric residents, and comorbidity were associated with inappropriate antibiotic use, and hence practitioners should never disregard these factors to prioritize those cases coming with them.