Evaluation of adherence to a protocol in the use of antimicrobials in acute lower infections in children during the winter of 2023.

Abstract

Background: Acute lower respiratory infections (ALRI) are a significant health issue. Although often viral in origin, they result in unnecessary antimicrobial (AM) prescriptions. Aim: To characterize the pattern of AM prescriptions in children hospitalized with ALRI who required respiratory support and to evaluate adherence to established therapeutic guidelines. Methodology: Observational, descriptive, retrospective study of patients under 15 years old hospitalized for ALRI, who received respiratory support in intensive and moderate care units during the winter of 2023. Clinical and laboratory variables and progression were analyzed. Patient characteristics were compared according to whether or not they adhered to the recommendation. Results: Of 381 children with ALRI, 155 (40%) received AM. In 241 (63%) cases, the recommendation was followed, whereas in 111 patients, AM were used despite not being recommended. In 20 cases where it was indicated, a different drug was used, and in 9 cases, AM were not used despite being recommended. Non-adherence was more common when the X-ray showed a tendency toward consolidation, atelectasis, and elevated acute phase reactants. Conclusions: More than half of the patients complied with the recommendation; non-adherence was associated with elevated reactants and pathological radiological findings. Identifying these factors is key to optimizing the indication in ALRI and to developing ongoing medical training initiatives.