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

## TL;DR

This study evaluates antimicrobial prescription practices in neonatal and pediatric wards in a South African hospital, finding frequent use of broad-spectrum drugs and poor documentation.

## Contribution

The study provides new insights into antimicrobial prescribing quality in African pediatric and neonatal inpatient settings.

## Key findings

- Antimicrobial use was highest in neonatal intensive care units and most prescriptions were empirical.
- Delayed administration and incomplete documentation were common, with only 23.2% of sepsis treatments initiated within 60 minutes.
- Broad-spectrum agents like ceftriaxone and meropenem were frequently prescribed, with suboptimal prescription quality overall.

## Abstract

There are limited data on antimicrobial prescribing quality in paediatric wards in African hospitals.

This study aimed to assess the quality of antimicrobial prescribing.

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.

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%.

Antimicrobial prescribing in these neonatal and paediatric wards showed frequent use of broad-spectrum agents, delayed administration and incomplete documentation.

The findings highlight the need for improved stewardship practices to promote timely, appropriate and well-documented antimicrobial use.