Antimicrobials, whether fully or partially synthetic, were categorized under this term according to contemporary definitions 1. While some antibiotics merely inhibited bacterial growth, others were capable of completely eradicating bacteria. Bacteriostatic agents impeded bacterial growth, whereas bactericidal agents destroyed bacteria. Drugs were defined as substances that produced biological effects on living organisms when administered to them. The term "antibiotic" originated from "antibiosis," which meant "against life." Initially, antibiotics were believed to be chemical substances produced by one microorganism that harmed other microorganisms by either killing them or preventing their growth 2.

Antibiotics functioned by disrupting the survival of bacteria through a specific Mode of Action (MOA). At therapeutic concentrations, they were strong enough to combat infections effectively while causing minimal harm 3. Recent studies have highlighted concerns regarding antibiotic prescribing practices in pediatric patients. Inappropriate antibiotic prescriptions have been associated with increased risks of adverse drug events and higher healthcare expenditures. 4. The specific MOA of an antibiotic disrupted bacterial survival, but, more importantly, at therapeutic doses, it was potent enough to fight infections effectively while posing little risk.

The antimicrobial efficacy of most classes of antibiotics targeted unique features of bacterial structures or their metabolic processes. The primary targets of antibiotics are illustrated in Figure 1 and included the following mechanisms of action:

Several databases, including PubMed, DELNET, MEDLINE, Science Direct, and the National Library, were consulted during the development of this technique. Numerous national and international papers were reviewed to gather the necessary data and create a patient information form. Various factors were considered and included in the patient information form to address the antibiotic prescribing patterns in the eastern Marathwada region of Maharashtra, aiming to achieve positive outcomes.

A prospective observational study was designed to collect information using the hospital administrative database, reviewing patient charts, and conducting interviews during ward rounds in the pediatric department of the District Civil Hospital, Dharashiv. This population-based, randomized prospective observational study was conducted at the Government District Hospital, Dharashiv (Maharashtra), India, from August 2023 to March 2024. The case sheets of pediatric patients required for the study were collected during ward rounds with proper permissions from the hospital authorities.

The study included 120 pediatric patients, both male and female, from various departments such as male pediatric and female pediatric wards at the Government District Hospital, Dharashiv. The case sheets of these 120 pediatric patients were followed up weekly, three times, by Doctor of Pharmacy students from the institution until the patients were discharged. Subjective evidence, objective evidence, and treatment plans were collected from the randomly selected case sheets. Demographic factors such as age, gender, disease prevalence, and drug treatment, particularly antibiotic usage, were considered essential for this study. The collected data were organized into spreadsheets and analyzed for assessment and interpretation.

In our study conducted at the Dharashiv district government hospital between August 2023 and March 2024, observed that 46.66% (N = 56) of the 120 admitted children were in the 0–5 years age group. This finding aligns with trends reported in various studies across different regions.

For instance, a study analyzing pediatric emergency department visits in the United States in 2009 found that children under 1 year of age accounted for 72% of hospital stays, while those aged 1–4 years comprised nearly 9%. 6

This research investigates the prevalence and associated risk factors of overweight and obesity among children aged 0–59 months in India. The study found that the prevalence of overweight/obesity among children in this age group was 2.6%. Factors such as child sex, age, birth weight, birth rank, maternal education, number of children, age at marriage, mother’s BMI, media exposure, social group, and dietary diversity score were significantly correlated with childhood overweight and obesity. 7

In the current study, around 36% fell between 31 to 40 kg, while the group with the fewest children, about 13%, had weights less than 10 kg. The majority of the participants in this study are from rural areas, that is 55% (N=66), the patients taking the antibiotic at a higher level is more in rural areas as compared to semiurban 30%(N=36) and urban areas 15% (N=18). This is similar to the study conducted, by Gebre Teklemariam Demoz et al, 2020. This study concludes that the consumption of antibiotics is higher in rural areas because of misinformation about antibiotic prescriptions.8 The average score for the route of administration was calculated to be 67.66, with a standard deviation of 41.30. Among the 120 cases examined, approximately 46% of patients received treatment via the intravenous (IV) route, while around 44% were administered medication orally. A smaller proportion, approximately 10% of cases, involved parenteral route administration. This distribution suggests a notable reliance on intravenous administration, followed closely by oral administration, in the treatment of pediatric patients at the Dharashiv district hospital. The relatively high percentage of IV administration may indicate the severity or urgency of cases requiring rapid and direct drug delivery into the bloodstream. Oral administration, being a common and convenient method, is understandably prevalent as well. The lower percentage of parenteral administration suggests that it is less frequently utilized, possibly due to factors such as the specific nature of the conditions being treated, patient age and condition, or hospital protocols. Overall, understanding the patterns of route administration provides valuable insights into treatment practices in pediatric care, aiding in the optimization of therapeutic approaches and resource allocation to ensure the best possible outcomes for young patients. Our study found that the majority of patients, around 77.5%, received empiric treatment, initiated based on clinical judgment. Definitive treatment, targeting specific pathogens, was administered to about 16.66% of patients, while prophylactic treatment was given to 5.83% of patients. This indicates a preference for proactive, symptom-based treatment, with a smaller proportion receiving targeted therapy based on confirmed diagnoses or preventive measures. This data provides insight into the antibiotic choices made in treating pediatric patients, highlighting the diverse range of antibiotics utilized in clinical practice. In our investigation, we observed that the majority of patients, around 72.72%, were treated with Amoxyclav. Additionally, 14.28% of patients received treatment with Quinine sulfate. This distribution indicates a notable preference for Amoxyclav (Amoxycillin and clavulanic acid) as the primary treatment choice among the patients included in our study, with a smaller proportion opting for Quinine sulfate.

This distribution underscores the variety of conditions affecting pediatric patients, with viral infections being the most common. The data provides insight into the antibiotic choices made in treating pediatric patients, highlighting the diverse range of antibiotics utilized in clinical practice.

The study on the prescribing patterns of antibiotics in pediatric patients at the Civil Hospital, Dharashiv, highlighted crucial insights into antibiotic use in the region. The findings revealed a predominant reliance on empiric treatment (77.5%) and significant use of antibiotics such as Penicillin (45.23%) and Cephalosporins (23.36%). Viral infections were the most common condition treated, emphasizing the need for careful evaluation to avoid unnecessary antibiotic prescriptions.

Moreover, the study underscores the necessity of adhering to Standard Treatment Guidelines (STG) to ensure the rational use of antibiotics, minimize resistance, and optimize patient outcomes. With rural areas representing a majority of the patients, targeted awareness campaigns and enhanced clinical practices are essential to improve antibiotic stewardship and safeguard public health.

We would like to acknowledge the management and principal of ASPM’S K.T Patil College of Pharmacy and the administration of the district government hospital for providing the necessary facilities to carry out the said research work.