Antibiotic use in children hospitalised with pneumonia in Central Vietnam

• Published in: Archives of disease in childhood Vol. 105; no. 8; pp. 713 - 719
• Main Authors: Nguyen, Phuong TK, Tran, Hoang T, Fitzgerald, Dominic A, Graham, Steve M, Marais, Ben J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.08.2020
• Subjects: Antibiotics; Antimicrobial agents; Ceftriaxone; Cefuroxime; Children; Children & youth; Diagnostic Tests; Drug resistance; Guidelines; Hospitals; Intravenous administration; Morbidity; Narcotics; Patient admissions; Patients; Pediatrics; Physicians; Pneumonia; Respiratory tract diseases; Statistical Analysis; Ventilation; United States > US; Asia; Vietnam; antibiotic; hospital cost; treatment guideline; antimicrobial resistance; childhood pneumonia
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2019-317733

Background and objectivesExcessive use of antibiotics has been noted in children with respiratory tract infections in Vietnam, but antibiotic use in hospitalised children is poorly documented. Antibiotic use and direct healthcare costs in children hospitalised with pneumonia in central Vietnam were assessed.MethodsA prospective descriptive study of children under 5 years old admitted with a primary admission diagnosis of ‘pneumonia’ to the Da Nang Hospital for Women and Children over 1 year.ResultsOf 2911 children hospitalised with pneumonia, 2735 (94.0%) were classified as ‘non-severe’ pneumonia by the admitting physician. In total, 2853 (98.0%) children received antibiotics. Intravenous antibiotics were given to 336 (12.3%) children with ‘non-severe’ and 157/176 (89.2%) children with ‘severe’ pneumonia; those with ‘non-severe’ pneumonia accounted for 68.2% (336/493) of intravenous antibiotics given. Only 19.3% (95/493) of children on intravenous antibiotics were stepped down to an oral antibiotic. Cefuroxime was the preferred oral agent, and ceftriaxone was the preferred injectable agent. Hospital admission for oral antibiotics in ‘non-severe’ pneumonia was a major cost driver, with an average direct cost of US$78.9 per patient, accounting for 54.0% of the total hospitalisation cost in the study cohort. In addition, 336 (12.3%) children with non-severe pneumonia received intravenous antibiotics without indication, accounting for a further 23.2% of hospitalisation costs.ConclusionLimiting unnecessary hospitalisation and considering early intravenous to oral step down antibiotic will reduce direct health system costs and morbidity in children with respiratory tract infections in Vietnam.