{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T22:55:31Z","timestamp":1793228131234,"version":"4.5.0"},"reference-count":36,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/objectives: Antimicrobial stewardship (AMS) is essential to optimize antibiotic use and limit antimicrobial resistance (AMR), particularly in pediatric populations where diagnostic uncertainty and system constraints complicate care. This study investigated critical AMS indicators, namely, missed antibiotic doses, microbiological diagnostics, and antibiotic prescribing at hospital discharge, which are key challenges that may affect treatment outcomes in hospitalized children under five years old. Methods: A prospective descriptive study was conducted in two tertiary pediatric hospitals in Zambia among children aged 29 days to 59 months. Information on missed antibiotic doses, microbiological investigations, and antibiotic prescribing at discharge from hospitalization was obtained from medical records and medication charts. Results: Patients experienced 1\u20138 missed doses, most commonly involving benzylpenicillin and ceftriaxone. Documentation of reasons for missed doses was largely absent. Microbiological testing was requested in 36.6% of patients, but only 14.8% of antibiotic prescriptions were supported by culture and susceptibility testing. Of requested tests, 80.9% of results were unavailable at discharge, limiting clinical utility. Only 19.1% of results were available, with a low culture positivity rate (27.3%). Overall, 41.8% of patients were discharged on antibiotics, predominantly from the WHO \u201cAccess\u201d group (78%), though 22% were \u201cWatch\u201d antibiotics, and none from the \u201cReserve\u201d group. Shorter hospital stay was significantly associated with discharge antibiotic prescribing (p = 0.0079; \u03c72 = 78.577, p &lt; 0.001). Conclusions: Significant AMS gaps exist, including frequent missed doses, limited diagnostic support, and high discharge antibiotic use. Strengthening medication administration systems, improving laboratory capacity and turnaround times, and optimizing discharge prescribing are critical for enhancing pediatric AMS and reducing AMR.<\/jats:p>","DOI":"10.3390\/antibiotics15090838","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T10:32:18Z","timestamp":1788258738000},"page":"838","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Missed Antibiotic Doses, Microbiology Diagnostic Results, and Antibiotic Prescribing Patterns at Discharge at Two Paediatric Tertiary Hospitals in Zambia: Implications for Antimicrobial Stewardship"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0262-4779","authenticated-orcid":false,"given":"Chileshe","family":"Lukwesa-Musyani","sequence":"first","affiliation":[{"name":"Institute of Basic Biological Sciences, Levy Mwanawasa Medical University, Lusaka P.O. Box 33991, Zambia"},{"name":"School of Public Health and Social work, Texila American University, Plantation Providence, East Bank Demerara (EBD), Georgetown Lot 24-42, Guyana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shadrick M.","family":"Ngosa","sequence":"additional","affiliation":[{"name":"General Medicine, Arthur Davison Children\u2019s Hospital, Ndola P.O. Box 240227, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mwelwa","family":"Chikombola","sequence":"additional","affiliation":[{"name":"General Medicine, Arthur Davison Children\u2019s Hospital, Ndola P.O. Box 240227, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Davis","family":"Sondashi","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Arthur Davison Children\u2019s Hospital, Ndola P.O. Box 240227, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Nayuda","family":"Kaonga","sequence":"additional","affiliation":[{"name":"Pharmacy Department, University Teaching Hospitals\u2013Children\u2019s Hospital, Lusaka P.O. Box 50110, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3193-8750","authenticated-orcid":false,"given":"Evans Mwila","family":"Mpabalwani","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,29]]},"reference":[{"key":"ref_1","unstructured":"WHO (2014). Antimicrobial Resistance: Global Report on Surveillance, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1002\/ped4.12292","article-title":"Antimicrobial stewardship program in pediatric medicine","volume":"5","author":"Probst","year":"2021","journal-title":"Pediatr. Investig."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"245","DOI":"10.2147\/PHMT.S224774","article-title":"Pediatric Antimicrobial Stewardship Programs: Current Perspectives","volume":"11","author":"Klatte","year":"2020","journal-title":"Pediatr. Health Med. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Principi, N., and Esposito, S. (2016). Antimicrobial stewardship in paediatrics. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-1772-z"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s11908-018-0644-7","article-title":"Pediatric Antimicrobial Stewardship: State of the Art","volume":"20","author":"Godbout","year":"2018","journal-title":"Curr. Infect. Dis. Rep."},{"key":"ref_7","unstructured":"UNICEF Data (2026, August 17). Monitoring the Situation of Children and Women Mortality Among Children, Adolescents and Youth Aged 5\u201324. Available online: https:\/\/data.unicef.org\/topic\/child-survival\/child-and-youth-mortality-age-5-24\/."},{"key":"ref_8","unstructured":"World Health Organization (WHO) (2022). Child Mortality (Under 5 Years), World Health Organization (WHO). Fact sheets."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e187428582206080","DOI":"10.2174\/18742858-v16-e2206080","article-title":"Child Mortality in Africa: An Infectious Disease Perspective","volume":"16","author":"Muhammad","year":"2022","journal-title":"Open Microbiol. J."},{"key":"ref_10","unstructured":"UNICEF, WHO, The World Bank Group, and UN Population Division (2017). Levels and Trends in Child Mortality: Report 2017, United Nations Inter-Group for Child Mortality Estimation."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/j.ajic.2021.11.016","article-title":"Reducing overuse of antibiotics at discharge home: A single-center mixed methods pilot study","volume":"50","author":"Giesler","year":"2022","journal-title":"Am. J. Infect. Control"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1093\/cid\/ciab842","article-title":"Antibiotic Overuse and Stewardship at Hospital Discharge: The Reducing Overuse of Antibiotics at Discharge Home Framework","volume":"74","author":"Vaughn","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"s16","DOI":"10.1017\/ash.2022.84","article-title":"Antibiotic stewardship strategies and antibiotic overuse after hospital discharge: Analysis of the ROAD Home Framework","volume":"2","author":"Vaughn","year":"2022","journal-title":"Antimicrob. Steward. Healthc. Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1017\/ice.2014.85","article-title":"Antibiotic Prescribing at the Transition from Hospitalization to Discharge: A Target for Antibiotic Stewardship","volume":"36","author":"Yogo","year":"2015","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1017\/ice.2025.59","article-title":"Discharge antibiotic prescribing at children\u2019s hospitals with established antimicrobial stewardship programs","volume":"46","author":"Same","year":"2025","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Kalasikam, M., Jimenez-Truque, N., Kloek, A.B., and Banerjee, R. (2025). Antibiotic overuse in a contemporary cohort of children hospitalized with influenza, RSV, or SARS-CoV-2: A retrospective cohort study. BMC Pediatr., 25.","DOI":"10.1186\/s12887-025-06165-8"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1111\/jpc.13506","article-title":"Missed opportunities for antimicrobial stewardship in pre-school children admitted to hospital with lower respiratory tract infection","volume":"53","author":"Walls","year":"2017","journal-title":"J. Paediatr. Child Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"ofab399","DOI":"10.1093\/ofid\/ofab399","article-title":"ADD It Up: An Evaluation of Antibiotic Duration at Hospital Dis-charge at a Community Hospital","volume":"8","author":"Conner","year":"2021","journal-title":"Open Forum Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1016\/j.cmi.2022.08.009","article-title":"The WHO essential medicines list AWaRe book: From a list to a quality improvement system","volume":"28","author":"Sharland","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e199","DOI":"10.1016\/S1473-3099(22)00726-5","article-title":"Multinational consensus antimicrobial stewardship recommendations for children managed in hospital settings","volume":"23","author":"McMullan","year":"2023","journal-title":"Lancet Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jss.2018.08.015","article-title":"The effects of missed doses of anti-biotics on hospitalized patient outcomes","volume":"233","author":"Patel","year":"2019","journal-title":"J. Surg. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.18203\/2319-2003.ijbcp20214497","article-title":"Medication omissions in the first 48 hours after admission: Failure in prescribed medicines reaching in-patients in paediatrics wards at the University Teaching Hospitals, Children\u2019s Hospital in Lusaka, Zambia","volume":"10","author":"Kampamba","year":"2021","journal-title":"Int. J. Basic Clin. Pharmacol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.jgar.2021.12.003","article-title":"A national, multicentre, web-based point prevalence survey of antimicrobial use and quality indices among hospitalised paediatric patients across South Africa","volume":"29","author":"Skosana","year":"2022","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e242","DOI":"10.1097\/INF.0b013e318286c612","article-title":"The Antibiotic Resistance and Prescribing in European Children Project: A Neonatal and Pediatric Antimicrobial Web-based Point Prevalence Survey in 73 Hospitals Worldwide","volume":"32","author":"Versporten","year":"2013","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e861","DOI":"10.1016\/S2214-109X(19)30071-3","article-title":"Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): An analysis of paediatric survey data from 56 countries","volume":"7","author":"Hsia","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Okeke, I.N., and Ojo, K.K. (2010). Antimicrobial use and resistance in Africa. Antimicrobial Resistance in Developing Countries, Springer.","DOI":"10.1007\/978-0-387-89370-9_17"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"WHO (2019). Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries: A WHO practical toolkit. JAC Antimicrob. Resist., 1, dlz072.","DOI":"10.1093\/jacamr\/dlz072"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/INF.0000000000002102","article-title":"Ideal and actual impact of rapid di-agnostic testing and antibiotic stewardship on antibiotic prescribing and clinical outcomes in children with positive blood cultures","volume":"38","author":"Reuter","year":"2019","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.idc.2014.01.002","article-title":"The role of the microbiology laboratory in antimicrobial stewardship programs","volume":"28","author":"Avdic","year":"2014","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e676","DOI":"10.1016\/S2214-109X(16)30221-2","article-title":"Antimicrobial resistance\u2014A threat to neonate survival","volume":"4","author":"Laxminarayan","year":"2016","journal-title":"Lancet Glob. Health"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Claeys, K.C., and Johnson, M.D. (2023). Leveraging diagnostic stewardship within antimicrobial stewardship programmes. Drugs Context, 12.","DOI":"10.7573\/dic.2022-9-5"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s12575-022-00182-y","article-title":"Combating the menace of antimicrobial resistance in Africa: A review on stewardship, surveillance and diagnostic strategies","volume":"24","author":"Gulumbe","year":"2022","journal-title":"Biol. Proced. Online"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2195","DOI":"10.1111\/apa.16508","article-title":"Addition of point-of-care test reduces antibiotic prescription in hospitalised children with suspected respiratory tract infection: A pre-test\u2013post-test study","volume":"111","author":"Hansen","year":"2022","journal-title":"Acta Paediatr."},{"key":"ref_34","first-page":"E139","article-title":"Hospital discharge in patients at risk of surgical site infection: Antimicrobial stewardship at Ferrara University Hospital, Italy","volume":"59","author":"Antonioli","year":"2018","journal-title":"J. Prev. Med. Hyg."},{"key":"ref_35","first-page":"e235","article-title":"Antibiotic Stewardship in Pediatrics","volume":"38","author":"Polat","year":"2019","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.yapd.2021.05.002","article-title":"Antibiotic Stewardship in Pediatrics","volume":"68","author":"Payton","year":"2021","journal-title":"Adv. Pediatr."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/9\/838\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T10:48:12Z","timestamp":1788259692000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/9\/838"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,29]]},"references-count":36,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["antibiotics15090838"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15090838","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,29]]}}}