Prescribing pattern of antimicrobials and adverse drug reactions in children suffering from lower respiratory tract infection in tertiary care hospital


  • Tarun Arora Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
  • Rudhra Prabhakar Kadali Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
  • Rakhamaji D. Chandane Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India
  • Chandrapal Gautam Department of Pharmacology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India



Antimicrobials, Adverse drug reactions, Lower respiratory tract infection


Background: Acute respiratory tract infections are leading cause of mortality in children in India. Further, indiscriminate use of antimicrobials has led to increased drug resistance and large number of adverse drug reactions (ADR). Therefore, aim of study was to study antimicrobial prescribing pattern and record incidence and causality assessment of ADRs in pediatric in-patients having lower respiratory tract infection (LRTI).

Methods: In this prospective and observational study total of 300 children aged 2 months to 12 years suffering from LRTI and hospitalized for minimum 48 hrs duration were included. A descriptive analysis was carried out to determine frequency and combinations of antibiotics prescribed and causality and number of ADRs.

Results: Out of 300 subjects, 70.3% of patients were males and 54.6% of cases with LRTI belonged to 2-6 months age group. The most frequently prescribed antibiotic was ceftriaxone alone in 67 (22.3%) patients while ceftriaxone and amikacin was the most common 2 drug combination in 60 (20%) patients. Ceftriaxone, ampicillin and gentamicin was most common 3 drug combination in 7 (2.3%) patients. There were 49 cases (16.3%) of ADRs and maximum were in 2-6 months age group and ceftriaxone with amikacin was associated with maximum number 10 (20.4%) of cases. Diarrhoea was most frequent adverse effect associated with antibiotics in 36 (76.6%) cases.

Conclusions: The use of cephalosporins (single or combination) are most commonly used drug and associated with maximum number of ADRs in 2-6 months male children with LRTI so clinicians should use them judiciously and rationally.


Kumari Indira KS, Chandy SJ, Jeyaseelan L, Kumar R, Suresh S. Antimicrobial prescription patterns for common acute infections in some rural and urban health facilities of India. Indian J Med Res. 2008 Aug;128(2):165-71.

Graffelman AW, Neven AK, le Cessie S, Kroes AC, Springer MP, van den Broek PJ. Pathogens involved in lower respiratory tract infections in general practice. Br J Gen Pract. 2004 Jan 1;54(498):15-9.

Kelsey MC, Mitchell CA, Griffin M, Spencer RC, Emmerson AM. Prevalence of lower respiratory tract infections in hospitalized patients in the United Kingdom and Eire-results from the Second National Prevalence Survey. J Hospital Infect. 2000 Sep 1;46(1):12-22.

Black RE. Zinc deficiency, infectious disease and mortality in the developing world. J Nutr 2003;133:1485-9.

Smith KR, Samet JM, Romieu I, Bruce N. Indoor air pollution in developing countries and acute lower respiratory infections in children. Thorax. 2000 Jun 1;55(6):518-32.

Peng D, Zhao D, Liu J, Wang X, Yang K, Xicheng H, et al. Multipathogen infections in hospitalized children with acute respiratory infections. Virol J. 2009 Dec;6(1):155.

Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. WHO Child Health Epidemiology Reference Group. Global estimates of the incidence of clinical pneumonia among children under five years of age. Bull World Health Organization. 2004;82:895-903.

Rosón B, Carratalà J, Dorca J, Casanova A, Manresa F, Gudiol F. Etiology, reasons for hospitalization, risk classes, and outcomes of community-acquired pneumonia in patients hospitalized on the basis of conventional admission criteria. Clin Infect Dis. 2001 Jul 15;33(2):158-65.

Hazir T, Nisar YB, Qazi SA, Khan SF, Raza M, Zameer S, et al. Chest radiography in children aged 2-59 months diagnosed with non-severe pneumonia as defined by World Health Organization: descriptive multicentre study in Pakistan. BMJ. 2006 Sep 21;333(7569):629.

Fields E, Chard J, Murphy MS, Richardson M. Assessment and initial management of feverish illness in children younger than 5 years: summary of updated NICE guidance. BMJ. 2013 May 22;346:f2866.

Khaled LA, Ahmad F, Brogan T, Fearnley J, Graham J, MacLeod S, et al. Prescription medicine use by one million Canadian children. Paediatr Child Health. 2001 Dec 1;8(suppl_A):6A-56A.

Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, et al. On behalf of the British thoracic society standards of care committee guidelines for the management of community acquired pneumonia in children. Brit Thoracic Society. 2011;66:4-23.

Smart K, Lemay J, Kel JD. Antibiotic choices by pediatrics residents and recently graduated pediatricians for typical infectious disease problems in children. Paediatr Child Health. 2006;11:647-53.

da Cunha A, Amaral J, Silva MA. Inappropriate antibiotic prescription to children with acute respiratory infection in Brazil. Indian Pediatr. 2003 Jan;40:7-12.

Bharathiraja R, Sridharan S, Chelliah LR, Suresh S, Senguttuvan M. Factors affecting antibiotic prescribing pattern in pediatric practice. Indian J Pediatr. 2005 Oct 1;72(10):877-9.

Sahu SK, Satapathy DM, Sahu T, Tripathy RM, Das BC, Pradhan S. A study of acute respiratory tract infection cases admitted to a tertiary level health centre. Health Population Perspectives Issues. 2002;25:186-95.

Clavenna A, Bonati M. Adverse drug reactions in childhood: a review of prospective studies and safety alerts. Arch Dis Childhood. 2009 Jun 15.

WHO. The use of the WHO-UMC system for standardized case causality assessment. Geneva: World Health Organization. 2011. Available at: Accessed 13 April 2012.

Lei HS, Rahman AF, Haq AS. Adverse drug reaction reports in Malaysia: comparison of causality assessments. Malays J Pharm Sci. 2007;5:7-17.

Javato-Laxer M, Navarro E, Littana R. Antimicrobial patterns in hospitals: determinants and proposed interventions. Philipp. J Microbiol Infect Dis. 1989;18:41-6.

Sjöqvist F. Drug safety in relation to efficacy: the view of a clinical pharmacologist. Pharmacol Toxicol. 2000 Jun;86:30-2.

McCaig LF, Besser RE, Hughes JM. Trends in antimicrobial prescribing rates for children and adolescents. JAMA. 2002 Jun 19;287(23):3096-102.

Bosu WK, Ofori-Adjei D. Survey of antibiotic prescribing pattern in government health facilities of the Wassa west district of Ghana. East African Med J. 1997 Mar;74(3):138-42.

Sectish TC, Prober CG. Pneumonia. Kliegman RM, Santon BF, St. Geme JW, Schor NF, Behrman RE. In: Nelson Textbook of Pediatrics, 19th ed. Elsevier Philadelphia PA; 2011:1432-35.

Palikhe N. Prescribing pattern of antibiotics in pediatric hospital of Kathmandu Valley. J Nepal Health Res Council. 2004;2:31-6.

Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998 Apr 15;279(15):1200-5.

Hoffman-Terry M, Fraimow H, Fox T, Swift B, Wolf J. Adverse effects of outpatient parenteral antibiotic therapy. Am J Med. 1999 Jan 1;106(1):44-9.




How to Cite

Arora, T., Kadali, R. P., Chandane, R. D., & Gautam, C. (2018). Prescribing pattern of antimicrobials and adverse drug reactions in children suffering from lower respiratory tract infection in tertiary care hospital. International Journal of Basic & Clinical Pharmacology, 7(11), 2240–2246.



Original Research Articles