Appropriateness of antimicrobial selection for treatment of pneumonia in selected public hospitals of Eastern Ethiopia: A cross-sectional study

Abstract

Objective: Inappropriate antimicrobial use leads to drug resistance and poor clinical outcomes. Considering the lack of data regarding the drug use patterns in the treatment of pneumonia in selected study areas, the authors felt compelled to assess the appropriateness of antimicrobial usage in the treatment of pneumonia at Hiwot Fana Specialized Comprehensive University Hospital and Jugal Hospital from May 1 to 31, 2021. Methods: A cross-sectional retrospective study was conducted using the medical cards of 693 admitted patients with pneumonia. The collected data were analyzed using SPSS version 26. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with an initial inappropriate antibiotic use. A p value of 0.05 was used to determine the statistical significance of the association using an adjusted odds ratio with 95% confidence interval. Results: Of the total participants, 116 (16.74%, 95% confidence interval: 14.1–19.6) of them received an initial inappropriate antimicrobial regimen. Ceftriaxone plus azithromycin was the most prescribed antimicrobial agent. Patients who were younger than 5 years (adjusted odds ratio = 1.71; 95% confidence interval: 1.00–2.94), between 6 and 14 years (adjusted odds ratio = 3.14; 95% confidence interval: 1.64–6.00), and older than 65 years (adjusted odds ratio = 2.97; 95% confidence interval: 1.07–2.66), with comorbid conditions (adjusted odds ratio = 1.74; 95% confidence interval: 1.10–2.72) and prescribed by medical interns (adjusted odds ratio = 1.80; 95% confidence interval: 1.14–2.84) were associated with an initial inappropriate antimicrobial use. Conclusion: Around one out of every six patients had received initial inappropriate treatments. Adherence to the recommendation of guidelines and attention to extreme-aged groups and comorbidity may improve antimicrobial use.