International Journal For Multidisciplinary Research

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Prescribing Patterns and Causality Assessment of Adverse Drug Reactions in Pediatric Inpatients with Respiratory Tract Infections: A Prospective Observational Study at a Tertiary Care Hospital

Author(s) Dr. Susheela Rani S, Ms. Janani A, Mr. Ankit Keshari, Ms. Annie Rose George
Country India
Abstract Objective: Respiratory tract infections (RTIs) are one of the leading causes of pediatric hospitalization globally and pose a significant risk of inappropriate prescribing and adverse drug reactions (ADRs). The purpose of this study was to evaluate the patterns of prescribing medications for pediatric patients with RTIs, measure the incidence and causation of ADRs, and determine clinical predictors of prolonged hospital stay in patients with RTIs who were hospitalized.

Methods: This was a prospective observational study that took place over six months at the Pediatrics Department at Tertiary care Hospital located in Rajajinagar, Bangalore, India. One hundred twenty-six pediatric patients between three months to 18 years of age, diagnosed with RTIs who were admitted to the hospital for inpatient treatment, were enrolled in the study. All data were collected on a pre-structured form. The severity of the patients' RTI was determined using the Pediatric Respiratory Severity Score (PRESS). To determine how frequently prescriptions were filled correctly per WHO's core prescribing indicators, the pattern of prescribing medications to these patients was also evaluated. ADRs were collected and evaluated using the Naranjo Criteria for Evaluation of ADRs. Participants were followed throughout their hospital admission until discharge; post-discharge follow-up was not performed. All statistical analyses were conducted using Chi-square, Mann-Whitney U, Kruskal-Wallis, Spearman's correlation coefficient, and logistic regression models.

Results: Upper respiratory tract infections (URTIs) were more frequent than lower respiratory tract infections (LRTIs) (65.08% vs 34.92%), with pharyngitis being the most frequently seen URTI (43.05%). In contrast, pneumonia was the most common LRTI (14.55%). The majority (53.71%) of respiratory tract infection (RTI) infections that occurred were mild in nature, while a severe infection had a statistically significant risk (p = 0.005) of 14.40 more odds of prolonged hospitalisation (11.11%).
A total of 691 medications were given per patient (6.85 ± 2.47 on average); antibiotics were given for 63.49% of the patient contacts, whereas injectable products were prescribed 88.09% of the time. Generic medicine was very common (86.22%). 10.32% of patients had an ADR associated with their treatment, out of those, 30.77% of patients had a neurological type of ADR, 23.07% had a cutaneous type of ADR, and in each case, antibiotics were responsible for 46.15% of the ADR cases. Additionally, patients less than 6 years old had increased odds (p = 0.025) of receiving multiple antibiotics than those older than 6 years old. Disease severity and the type of RTI were the major predictive factors for corticosteroid & bronchodilator use.

Conclusion: RTI prescribing practices in the pediatric inpatient setting are primarily influenced by the severity of disease and type of RTI, as compared to the patient demographic characteristics. The findings of high levels of antibiotic and injectable medication usage; polypharmacy; and a high incidence of ADRs in this population suggest that there is an immediate need for evidence-based prescribing, antimicrobial stewardship, and formalized pharmacovigilance in pediatric inpatient settings.
Keywords Respiratory tract infections; pediatric inpatients; prescribing patterns; adverse drug reactions; Naranjo scale; WHO prescribing indicators; antimicrobial stewardship; PRESS score.
Field Medical / Pharmacy
Published In Volume 8, Issue 5, September-October 2026
Published On 2026-09-05
DOI https://doi.org/10.36948/ijfmr.2026.v08i05.87155
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