Evaluation and Comparison of Antibiotic Prescribing Practices and Treatment Outcomes in Children with Pneumonia Admitted to Public and Private Hospitals in Pakistan: A Retrospective Study

BACKGROUND: Pneumonia remains a leading cause of mortality among children under five years worldwide, particularly in Pakistan. AIM: This study aimed to evaluate antibiotic prescribing practices, diagnostic utilization, and treatment outcomes among hospitalized children with pneumonia in public and private hospitals in Lahore, Pakistan. METHODOLOGY: A retrospective observational study was conducted using medical records from a public and private hospital between January and December 2021. Children aged ≤ 59 months with clinically diagnosed pneumonia were included. Pneumonia severity was classified according to World Health Organization (WHO) criteria, and antibiotic appropriateness was assessed using WHO guidelines in combination with the Gyssens classification system. RESULTS: Among the study population, 68.7% had severe pneumonia, 17.4% non-severe pneumonia, and 13.9% very severe pneumonia. Diagnostic support was limited with chest radiographs performed in 84.2% of cases; whereas microbiological testing was low 10.2%. Streptococcus pneumoniae was the most commonly identified pathogen. Antibiotic therapy was predominantly empirical (89.2%), particularly in public hospitals. Ceftriaxone was the most frequently prescribed antibiotic (84.4%), often prescribed regardless of disease severity. Only 2.8% of prescriptions adhered to WHO treatment guidelines, while Gyssens analysis showed that 97.3% of prescriptions were inappropriate, primarily due to incorrect duration and suboptimal antibiotic selection. Treatment outcomes indicated that only 29.2% of patients were successfully discharged, while 70.8% left against medical advice (LAMA). A significant difference in outcomes was observed between public and private hospitals, with a higher discharge rate in private settings and increased LAMA in public hospitals. CONCLUSION: This high LAMA rate likely reflects socioeconomic constraints, caregiver-related factors, and healthcare system limitations. These findings major gaps in guideline adherence, diagnostic capacity, and rational antibiotic use. Implementation of antimicrobial stewardship programs, improved diagnostic facilities, and strict adherence to WHO guidelines are essential to optimize clinical outcomes and reduce antimicrobial resistance.