Prescription precision: Evaluating antimicrobial prescription practices in paediatric and neonatal inpatients

Abstract

Background: There are limited data on antimicrobial prescribing quality in paediatric wards in African hospitals.
Objectives: This study aimed to assess the quality of antimicrobial prescribing.
Method: We conducted weekly point prevalence surveys (PPSs) (15 March 2025 – 05 April 2025), assessing antimicrobial use and prescribing quality in neonatal and paediatric medical wards at Tygerberg Hospital, Cape Town, South Africa. Inpatients with active antimicrobial prescriptions at 08:00 on PPS days were included, collecting data on demographics, antimicrobials, prescription quality and time to administration (hangtime) using electronic surveys.
Results: We reviewed 842 prescription charts, of which 237 (28.1%) included antimicrobial agents (23.3% neonates vs 34.4% paediatric patients; p < 0.001). Antimicrobial use was highest in the neonatal intensive care unit (58.5%) and lowest in neonatal wards (20.0%). Most antimicrobial therapy was empiric (89.0%), with pneumonia (49.2%) leading in paediatric patients and sepsis (43.2%) in neonates. Ceftriaxone (20.9%) dominated paediatric use, while ampicillin (20.4%) and meropenem (16.7%) predominated in neonates. Overall, 49.8% of agents were ‘Access’, 49.3% ‘Watch’ and 0.9% ‘Reserve’ from the World Health Organization ‘AWaRe’ classification. The intravenous route of administration predominated (79.0%). Median treatment duration was 5 days (interquartile range [IQR] 5–7 days). In patients with sepsis, the median hangtime was 109 min (IQR 30 min – 205 min), with only 23.2% initiated within 60 min. Prescription quality was suboptimal: allergies were documented in 37.1%, infection source in 29.0% and stop dates in 38.0%.
Conclusion: Antimicrobial prescribing in these neonatal and paediatric wards showed frequent use of broad-spectrum agents, delayed administration and incomplete documentation.
Contribution: The findings highlight the need for improved stewardship practices to promote timely, appropriate and well-documented antimicrobial use.