Assessment of Paediatric Antibiotic Prescriptions Practice Among Hospitalized Children Using WHO AWaRe Guidelines in Sulaimani City, Iraq

Abstract

Background: Inappropriate antibiotic use among hospitalised children is a growing concern, particularly in low- and middle-income countries.  Objective: The study aims to evaluate the rationality of antibiotic prescription practices among hospitalized children in a major referral hospital in Sulaimani, Iraq, using the World Health Organisation AWaRe classification as a benchmark. Methods: A cross-sectional study with a convenience sampling method was conducted on 600 patients from January to April 2025 at Dr Jamal Ahmad Rashid Paediatric Teaching Hospital. Data were collected from inpatients on wards, in the Intensive Care Unit, and in the Neonatal Intensive Care Unit using the interview method, medical record reviews, and a structured questionnaire aligned with WHO standards. Statistical analyses were performed using SPSS version 25. Results: Out of 600 patients, 435 (72.5%) received antibiotics. The most prescribed antibiotics were Ceftriaxone (31.4%) and Cefotaxime (16.7%). According to WHO, AWaRe classification, 65.8% of prescriptions were from the Watch group, 33.7% from Access, and 0.4% from the Reserve group. Only 8.9% underwent culture and sensitivity testing. Modifications to the antibiotic regimen were implemented in 70% of positive culture cases. Patients prescribed antibiotics had a higher discharge cure/stable rate (86.1%) but also accounted for all reported mortalities (3.9%). Conclusion: Antibiotic prescribing practices at the hospital show substantial reliance on Watch group antibiotics and limited microbiological guidance, highlighting potential misuse. Strengthen antimicrobial stewardship programs, increase microbiological testing, promote prescriber education, and encourage adherence to WHO guidelines to ensure rational antibiotic use and curb resistance.