Pediatric empiric antibiotic use and resistance patterns at a single tertiary care hospital in Tanzania

BACKGROUND: Despite growing microbiology capacity in Tanzanian public hospitals, pediatric-specific antibiograms remain rare, and patterns of empiric antibiotic use in emergency care are poorly described compared to high-income settings. Understanding resistance profiles and empiric prescribing practices is essential for developing successful pediatric antimicrobial stewardship (AMS) programs. OBJECTIVES: To assess baseline pediatric empiric antibiotic use in the emergency medical department (EMD) and microbiology results from children at Muhimbili National Hospital (MNH), a tertiary care center and referral hospital in Dar es Salaam, Tanzania. DESIGN: We retrospectively reviewed the electronic medical records of children seen in the EMD over a one-year period to document empiric antibiotic use and indications. Blood and urine cultures were analyzed to construct a pediatric-specific antibiogram and assess resistance patterns. RESULTS: Of 2,316 patients prescribed antibiotics, lower respiratory infection (n = 532, 23%), prophylaxis (n = 380, 16%), and upper respiratory infection (n = 277, 12%) were the most common single indications for use. Ceftriaxone was the most frequently used antibiotic (n = 1,658, 72%). Microbiology data revealed low susceptibility of gram-negative isolates to ceftriaxone: 20% (10/49) in K. pneumoniae and 18% (9/51) in E. coli. Over 90% of Enterobacterales met criteria for multidrug resistance (MDR). CONCLUSIONS: Ceftriaxone was the most common empiric antibiotic, particularly for lower respiratory infections. Antibiotic treatment selection aligned with local sepsis guidelines, emphasizing broad criteria for therapy rather than national, source-directed infectious disease treatment guidelines. Resistance data demonstrated frequent ceftriaxone resistance among gram-negative organisms. Future studies are needed to understand clinicians' use of bacterial cultures and clinical outcomes in children with resistant isolates. Quality improvement initiatives should incorporate regular review of antibiotic prescribing patterns and microbiology data to ensure treatment guidelines reflect local epidemiology.