# Appropriateness of Antibiotic Prescription Among Children Under 5 Years: A Cross‐Sectional Study in a Ghanaian Regional Hospital

## TL;DR

This study finds that over 60% of antibiotic prescriptions for children under 5 in a Ghanaian hospital were inappropriate, risking antibiotic resistance.

## Contribution

Quantifies high rates of inappropriate antibiotic prescriptions in Ghanaian pediatric care and identifies infection types most affected.

## Key findings

- 62.7% of antibiotic prescriptions for children under 5 were inappropriate based on guidelines.
- Respiratory tract infections had the highest odds of inappropriate prescriptions (aOR = 3.82).
- Cephalosporins were the most commonly misprescribed antibiotic class.

## Abstract

Misuse of medications, particularly antibiotics, severely impacts the standard of care and can result in antibiotic resistance. Antibiotic resistance is a growing problem in Ghana, compromising patient outcomes. This study aims to assess antibiotic prescription pattern and level of inappropriateness based on Standard Treatment Guideline (STG) recommendations in children under 5 years.

An analytical cross‐sectional study design was used to assess antibiotic prescription in children under 5 years attending the Wa Regional Hospital in Ghana. Medical records of pediatric outpatients from January to December 2022 were reviewed. Patients' sociodemographic characteristics, prescribed antibiotics, principal diagnosis, dose, and duration were extracted using a semi‐structured form. Prescriptions with clinical indication, dose, and duration which did not meet the requirements of the STG were coded as inappropriate. Data were analyzed and factors associated with inappropriate antibiotic prescription were determined using logistic regression.

Children's mean age was 2.95 ± 1.20 years, with males comprising 54.5%. Most patients had NHIS coverage (90.6%). This study reports 62.7% (266/424) inappropriate antibiotic prescriptions in children under 5 years with infections. The most common classes of antibiotics wrongly prescribed were cephalosporin 54.3% (230/424), penicillin 21.7% (92/424), and aminoglycoside 12.5% (53/424). The class of principal diagnoses likely to have inappropriate antibiotic prescriptions included respiratory tract infections (aOR = 3.82; 95% CI = 2.13, 6.85; p < 0.0001) and urinary tract infections (aOR = 0.21; 95% CI = 0.11, 0.41; p < 0.0001).

Prevalence of inappropriate prescription of antibiotics was high among the study population, and this was strongly associated with respiratory and urinary tract infections. This study highlights the need to monitor antibiotic prescriptions in hospitals to ensure treatment effectiveness and combat antimicrobial resistance.