This study reveals significant deviations from national guidelines in antimicrobial use for treating community-acquired pneumonia (CAP) in Vietnamese children, particularly highlighting excessive third-generation cephalosporin dosing and over-reliance on intravenous antibiotics. It systematically analyzes internal and external barriers to guideline compliance and proposes interventions, including national guideline updates and strengthening antimicrobial stewardship programs (AMS), offering critical directions for reducing antimicrobial resistance (AMR).
Literature Overview
This article titled 'Barriers to Compliance with National Guidelines Among Children Hospitalized with Community-Acquired Pneumonia in Vietnam and the Implications', published in the journal Antibiotics, reviews antimicrobial usage patterns and adherence challenges in pediatric CAP treatment within Vietnam. While Vietnam was the first country in the WHO Western Pacific Region to develop a national action plan on antimicrobial resistance (NAP), implementation faces substantial challenges, particularly low compliance rates in primary and tertiary healthcare facilities.
Background Knowledge
Community-acquired pneumonia (CAP) remains a leading cause of mortality among children aged 1-59 months, especially in low- and middle-income countries (LMICs) where antimicrobial resistance (AMR) is escalating. Despite WHO's AWaRe classification system advocating increased use of 'Access' group antibiotics to mitigate AMR, 73.3% of antibiotics administered in Vietnamese hospitals still belong to the 'Watch' category, with 91.4% of children receiving intravenous antibiotics. Through analysis of clinical data from a major Vietnamese hospital, this study investigates factors contributing to low guideline adherence and proposes improvements in antimicrobial management to enhance pediatric CAP care quality while reducing AMR risks.
Research Methods and Experiments
This mixed-methods study reviewed medical records of 108 Vietnamese pediatric CAP inpatients to analyze antibiotic usage patterns, including drug categories, dosing regimens, administration routes, treatment duration, and microbiological testing practices. Subsequently, in-depth interviews were conducted with 5 pediatricians involved in CAP treatment to identify barriers affecting guideline adherence, such as physician experience, drug supply stability, guideline update frequency, and pre-admission antimicrobial exposure.
Key Conclusions and Perspectives
Research Significance and Prospects
The study underscores Vietnam's urgent need to update CAP treatment guidelines and strengthen antimicrobial stewardship programs (ASPs) to improve treatment compliance and reduce AMR. Future efforts should integrate WHO's AWaRe classification system, optimize therapy recommendations based on local resistance patterns, enhance physician training, implement rational drug-use support systems, and promote early transition from intravenous to oral administration. Additionally, hospital pharmacy departments should actively participate in managing antibiotic supply shortages to ensure effective guideline implementation.
Conclusion
This study demonstrates significant guideline deviations in pediatric CAP antimicrobial treatment within Vietnamese hospitals, characterized by excessive third-generation cephalosporin dosing, high intravenous antibiotic rates, and less than 5% adherence to national guidelines. Physicians reported outdated guidelines with limited flexibility and unstable drug supply as key implementation challenges. Recommendations include guideline revisions by the Vietnamese Ministry of Health, adoption of WHO's AWaRe classification, strengthening of antimicrobial stewardship programs, and enhanced prescription training through collaboration between pharmacy departments and medical schools. Further improvements should focus on optimizing antibiotic supply chains and prescription software systems to reduce AMR and improve CAP treatment outcomes for children.
