Antibiotic prescribing practices and appropriateness of prescriptions in outpatient paediatric acute respiratory tract infections in Viet Nam

Abstract Background Antimicrobial resistance (AMR) is a growing challenge caused by many factors including antibiotic overprescribing. We sought to understand prescribing practices and appropriateness of antibiotic prescriptions for paediatric acute respiratory tract infections (ARIs) in commune health centres in one province in northern Viet Nam to help identify potential factors associated with overprescribing and areas to target for intervention to reduce AMR. Methods We performed a retrospective review of electronic health records for paediatric outpatient encounters with an ARI diagnosis in 112 commune health centres between 1 January and 31 December 2019. We analysed patterns of antibiotic prescriptions, including classification using the WHO Access, Watch and Reserve (AWaRe) classification. We evaluated antibiotic appropriateness for acute pharyngitis using decision trees based on local guidelines. Mixed-effects logistic regression was used to examine factors associated with antibiotic prescribing decisions. Results A total of 35 675 encounters were reviewed. Of all encounters, 34 673 (97.2%) received antibiotics and 4268 (12.3%) encounters had a Watch group prescription. The most frequent diagnosis was acute pharyngitis (21 269, 59.6%), of which 20 826 (97.9%) encounters were prescribed antibiotics. Appropriateness of antibiotic prescriptions for acute pharyngitis diagnoses varied by guideline used. Conclusions Antibiotics are frequently prescribed for paediatric ARIs in Viet Nam. Acute pharyngitis was the most common diagnosis, with many antibiotics prescribed inappropriately. Provider awareness about available guidelines alongside updated changes to guidelines may help improve prescribing practices and help decrease the burden of AMR in Viet Nam.