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Abstract
Background: Hospital management of childhood pneumonia rests on appropriate antibiotic therapy supplemented by supportive medicines, but documented prescribing patterns for these supportive co-medications in Khyber Pakhtunkhwa are scarce.
Objective: To describe the drug-combination prescribing patterns used for children hospitalized with pneumonia in tertiary care hospitals in Peshawar, and to explore whether the number of co-prescribed agents was related to documented drug–drug interaction level.
Methods: A retrospective, cross-sectional chart review was conducted on 180 children aged 2 months to 12 years with clinically confirmed pneumonia receiving documented pharmacotherapy (non-probability convenience sampling). Regimens were classified into five categories and re-expressed as class-level exposure (bronchodilator, corticosteroid, paracetamol) and number of agents. Proportions are reported with Wilson 95% confidence intervals; a Cochran–Armitage test assessed trend in documented interaction across number of agents.
Results: One hundred and forty-eight children (82.2%; 95% CI 76.0–87.1) received combination therapy and 32 (17.8%) received an antibiotic alone. The leading regimens were antibiotic + bronchodilator (24.4%), antibiotic + bronchodilator + paracetamol (23.9%) and antibiotic + corticosteroid (23.3%). Bronchodilators were prescribed to 48.3% of children, paracetamol to 34.4% and corticosteroids to 23.3%. One adjunct was added in 58.3% and two in 23.9%. Any documented interaction occurred in 29.4% overall and did not trend with the number of agents (34.4%, 28.6% and 27.9% for none, one and two adjuncts; p = 0.569).
Conclusion: Adjunctive co-prescribing is the norm rather than the exception in hospitalized pediatric pneumonia in Peshawar, with bronchodilators the most frequent add-on. The documented interaction burden did not rise with regimen complexity. Indication-level data and stewardship audit are needed to judge the appropriateness of these adjuncts.