Global Patterns of Inappropriate Pediatric Outpatient Antibiotic Prescribing: A Systematic Review and Meta-analysis Across Diverse Healthcare Settings
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Abstract
Background: Inappropriately prescribed antibiotics in pediatric outpatient care remain one of the most significant global drivers of antimicrobial resistance. Diagnostic uncertainty, excessive treatment duration, and reliance on broad-spectrum agents continue to compromise the quality of prescribing notwithstanding various stewardship initiatives. Aim and Objective: This systematic review and meta-analysis were done to assess the magnitude of inappropriate pediatric outpatient antibiotic prescribing across diverse global healthcare settings. Research Question: What is the overall proportion of inappropriate or guideline-discordant antibiotic prescriptions in pediatric outpatient care, and how consistent are these findings across international studies? Methods: Four databases were searched following PRISMA-2020 guidelines from 2018 to 2025. Of the results, ten studies met the inclusion criteria for qualitative synthesis, and eight provided extractable data for meta-analysis. A random-effects model synthesized proportions of non-optimal prescribing (p). Heterogeneity, funnel asymmetry, and meta-regression diagnostics were conducted in RStudio. Results: In the eight quantitative studies, the proportion of inappropriate or guideline-discordant antibiotic prescribing ranged from 0.210 to 0.848 (n = 14,393,085). The overall pooled meta-analytic estimate was greater than 0.60, showing that more than 60% of pediatric outpatient prescriptions were non-optimal globally. Significant heterogeneity (high I²), asymmetry in the funnel plot, and Egger's test supported variability influenced by study size and setting characteristics. Conclusion: Suboptimal antibiotic prescribing is common worldwide in pediatric outpatient care, driven by excessively long duration, overuse of broad-spectrum agents, and unnecessary treatment of viral illnesses. Strengthened, context-specific stewardship efforts are urgently needed.
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Copyright (c) 2025 Sakthivel S, Preyeamvadha R, Akshai B, Jamila Hameed
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons License All articles published in Annals of Medicine and Medical Sciences are licensed under a Creative Commons Attribution 4.0 International License.
Sakthivel S, Department of Paediatrics, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, 678103, India.
Department of Paediatrics, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, 678103, India.
Preyeamvadha R, Department of Paediatrics, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, 678103, India.
Department of Paediatrics, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, 678103, India.
Akshai B, Department of Paediatrics, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, 678103, India.
Department of Paediatrics, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, 678103, India.
Jamila Hameed, Research Mentor, Department of OBG, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, 678103, India.
Research Mentor, Department of OBG, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, 678103, India.
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