Drug utilization of antimicrobial agents, treatment outcome, cost of treatment, and awareness of parents of children admitted with infectious diseases in a tertiary care hospital, India: A cross-sectional observational study

Background: Antimicrobial agents (AMAs) are often used in the pediatric population without age-specific dosing guidelines, leading to concerns over efficacy, resistance, and cost. This study evaluated prescription patterns, AMA utilization, treatment outcomes, cost of therapy, and parental awareness in children admitted with infectious diseases in a tertiary care hospital. Materials and Methods: This was a cross-sectional observational study conducted over 18 months in 378 children aged >1 month to ≤12 years who received at least one AMA following ethics committee permission and written informed consent. Pediatric drug utilization was assessed using Child Defined Daily Dose (cDDD), Child Drug Utilization Index (cDUI), and Prescribed Daily Dose (PDD)/cDDD ratio. Treatment outcome was measured with the duration of the febrile period and hospitalization. Parental awareness was measured through a validated questionnaire. Cost analysis included direct and indirect costs. Descriptive statistics were used. Results: Average number of AMAs was 2.7/patient. Ceftriaxone (21.2%) was the most commonly prescribed AMA, with PDD/cDDD ratios >1.8 across age groups. Vancomycin had appropriate dosing (PDD/cDDD ~1.0), while piperacillin-tazobactam showed underdosing. Empirical therapy resulted in clinical improvement in 65.1%. The average total treatment cost was INR 13,997, with indirect costs constituting 64.8%. While 95.5% of parents were aware of their child’s illness, awareness of AMA side effects and antimicrobial resistance was low (34.2% and 16.6%, respectively). Awareness correlated positively with socioeconomic status. Conclusion: AMA usage in hospitalized children was mainly as per guidelines and within expected utilization ranges, although dose variations exist. Clinical outcomes were favorable, with minimal direct costs. Enhancing parental education on AMA use and resistance is essential for optimizing pediatric care.