Evaluation of the Appropriateness of Antibiotic Use in Children Under 5 Years Old with Acute Diarrhea According to Clinical Practice Guidelines at Sawanpracharak Hospital

Abstract

This explanatory sequential mixed-methods study aimed to examine antibiotic prescribing and its appropriateness, as well as the contexts related to prescribing decisions among children under 5 years of age with acute diarrhea. The quantitative phase involved a retrospective review of 400 medical records from 2021 to 2025, selected through systematic sampling proportional to the number of patients in each year. Appropriateness among antibiotic recipients was assessed in terms of indication, drug selection, dosage, and treatment duration. In the qualitative phase, semi-structured interviews were conducted with 12 physicians. Data were analyzed using descriptive statistics, association analyses, and content analysis. The findings were subsequently integrated using a joint display. The study was conducted from June 16 to July 31, 2026.

The results showed that 104 of the 400 patients (26.00%) received antibiotics, while 67 of the 278 outpatients (24.10%) received antibiotics. Ceftriaxone was the most frequently prescribed antibiotic. Among the 104 antibiotic recipients, 54 prescriptions (51.92%) were appropriate across all components, whereas 50 (48.08%) were inappropriate in at least one component. Inappropriate indication was the most common problem, occurring in 36 patients (34.62%). In univariable analyses, outpatient care (OR = 2.73; 95% CI: 1.18–6.33; p = 0.024) and the absence of stool testing (OR = 4.91; 95% CI: 1.88–12.87; p = 0.001) were associated with inappropriate antibiotic use. The interviews indicated that clinical uncertainty, workload, parental expectations, and limitations of decision-support systems were related to prescribing practices. In conclusion, nearly half of the antibiotic recipients had inappropriate antibiotic use in at least one component, with inappropriate indication being the most common problem. These findings may be used to support the development of measures promoting rational antibiotic use. Guideline adherence, prescription review, and clinical decision-support systems should therefore be strengthened.