Suboptimal antibiotic prescribing for pediatric community-acquired pneumonia (CAP) contributes to avoidable harm and the development of antimicrobial resistance. Evidence on the impact of pharmacist-led antimicrobial stewardship interventions in low- and middle-income countries is limited. This study evaluated whether a structured, pharmacist-led program could improve antibiotic prescribing appropriateness for children hospitalized with CAP at a provincial maternal and pediatric referral hospital in Vietnam.
The authors used a quasi-experimental before-and-after design. Medical record review compared antibiotic prescribing for two six-month periods: January–June 2024 (pre-intervention) and January–June 2025 (post-intervention). The setting was a provincial maternal and pediatric referral hospital in Vietnam. All data were derived from paper-based medical records.
The stewardship intervention was led by pharmacists and included multiple, locally adapted measures:
These components were implemented together as a structured package; the abstract does not disaggregate the individual effect of each component.
Eligible records were unique inpatient encounters for children aged 2 months to 5 years with a primary diagnosis of CAP who received systemic antibiotics. Monthly stratified systematic sampling yielded 560 unique paper records total: 280 from the pre-intervention period and 280 from the post-intervention period. The study relied on existing clinical documentation; additional data sources beyond the medical records are not described in the abstract.
Appropriateness was evaluated against four reference sources: the hospital protocol, Vietnamese national guidance, the Vietnam National Drug Formulary, and manufacturer information. The assessment included overall appropriateness and component domains such as dose and dosing interval. The abstract does not report definitions for other appropriateness domains (for example, drug selection or duration) beyond dose and dosing interval, nor details on adjudication processes.
The primary outcome reported was the proportion of prescriptions judged appropriate. Secondary reported measures included domain-specific appropriateness (dose and dosing interval). The study compared proportions between the pre- and post-intervention periods and conducted exploratory univariable logistic regression to identify factors associated with inappropriate prescribing before the intervention.
Proportions of appropriateness were compared between the two periods and reported with p values. Exploratory univariable logistic regression identified factors linked to inappropriate prescribing in the pre-intervention sample. Reported associations included age and use of combination therapy as predictors of inappropriateness. The abstract does not report multivariable analyses, adjustment for potential confounders, or effect sizes beyond odds ratios for the two reported factors.
Overall appropriateness improved substantially after the intervention: from 60.36% (169/280) pre-intervention to 86.79% (243/280) post-intervention (p < 0.001).
Dose appropriateness increased from 67.14% to 90.71% (p < 0.001). Dosing-interval appropriateness increased from 90.36% to 98.57% (p < 0.001). These domain improvements were the primary drivers of the overall increase in prescribing appropriateness.
In the pre-intervention period, exploratory univariable logistic regression found that age < 12 months was associated with higher odds of inappropriate prescribing (odds ratio 2.1, 95% CI 1.3–3.5; p = 0.003). Use of combination therapy was also associated with inappropriate prescribing (odds ratio 4.6, 95% CI 1.75–12.1; p = 0.001).
A structured, pharmacist-led antimicrobial stewardship intervention was associated with a substantial and statistically significant improvement in antibiotic prescribing appropriateness for pediatric CAP in this provincial Vietnamese hospital. The observed gains were driven mainly by better dose selection and dosing-interval adherence. The authors interpret these findings as support for sustained pharmacist participation in pediatric antimicrobial stewardship programs at provincial hospitals in Vietnam.
The abstract provides robust pre/post outcome data but does not report several implementation and outcome details. Specific limitations and unreported items in the abstract include:
Where those details are important for implementation or generalizability, they were not reported in the abstract and would require consultation of the full manuscript.
These results suggest that in similar low- and middle-income hospital settings, embedding pharmacists in antimicrobial stewardship activities—using a package of adapted guidance, education, accessible prescribing tools, and targeted audit-and-feedback—can markedly improve antibiotic prescribing appropriateness for pediatric CAP, particularly by correcting dosing and dosing-interval errors. The pre-intervention associations indicate infants (< 12 months) and patients receiving combination therapy are high-yield targets for stewardship review.
In a quasi-experimental before-and-after study of 560 pediatric CAP admissions at a provincial Vietnamese hospital, a structured pharmacist-led antimicrobial stewardship intervention was associated with significant improvements in overall prescribing appropriateness (60.36% to 86.79%), dose appropriateness, and dosing-interval appropriateness. The study supports ongoing pharmacist engagement in pediatric stewardship in provincial hospital settings. The abstract does not provide data on clinical outcomes, costs, or long-term sustainability; those details would require the full article.