High prescribing rates of third-generation cephalosporins in children hospitalized with acute lower respiratory infections at a university hospital

Int J Infect Dis. 2021 Jan:102:369-374. doi: 10.1016/j.ijid.2020.10.105. Epub 2020 Nov 10.


Objective: Antibiotics are frequently prescribed for the treatment of acute lower respiratory infections (ALRI) in children ≤5 years of age, even though viral aetiologies are the most common. The aim of this study was to describe antibiotic prescribing rates and patterns in children ≤5 years of age hospitalized with ALRI.

Methods: A retrospective study was conducted involving patients aged 1 month to 5 years hospitalized with ALRI at a university hospital. Patient demographics, ALRI diagnosis, microbiological data, antibiotics prescribed, and treatment outcomes were recorded and analysed.

Results: A total of 1283 patients were enrolled. Their median age was 1.6 years (interquartile range 0.8-2.8 years). Thirty-six percent had a co-morbidity. The diagnosis at discharge was viral ALRI in 81% and bacterial pneumonia in 19%. The mortality rate was 0.4%. The overall antibiotic prescribing rate was 46% (95% confidence interval 43-49%). Antibiotic prescribing rates were higher among children with co-morbidities (65% vs 35%, p < 0.001) and older children (57% for >2-5 years vs 39% for ≤2 years, p < 0.001). Parenteral third-generation cephalosporins were prescribed in up to 68% of all prescriptions.

Conclusions: Nearly-half of hospitalized children with ALRI were prescribed antibiotics. The majority of prescribed antibiotics were third-generation cephalosporins. An antimicrobial stewardship programme and antibiotic guidelines should be implemented to promote the judicious use of antibiotics.

Keywords: Acute lower respiratory infections; Antibiotics; Antimicrobial stewardship; Community-acquired pneumonia; Paediatrics.

MeSH terms

  • Acute Disease
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship*
  • Cephalosporins / therapeutic use*
  • Child, Preschool
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • Hospitals, University
  • Humans
  • Infant
  • Male
  • Respiratory Tract Infections / drug therapy*
  • Respiratory Tract Infections / microbiology
  • Retrospective Studies


  • Anti-Bacterial Agents
  • Cephalosporins