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PaediatricsMD Paediatrics

Antibiotic Resistance Patterns in Community-Acquired Pneumonia in Children Under 5 Years: A Hospital-Based Observational Study

Dr. Meena Krishnan¹, Dr. Vijay Nair², Dr. Asha Reddy¹

¹ Dept. of Paediatrics, Madras Medical College, Chennai · ² Dept. of Microbiology

P3

PEDICON 2025 — Annual Conference of Indian Academy of Paediatrics

Background
  • Community-acquired pneumonia (CAP) is the leading cause of under-5 mortality in India — 127,000 deaths annually (UNICEF 2023)
  • Rising amoxicillin resistance (up to 48% in some Indian states) threatens first-line WHO IMCI treatment protocols
  • Blood culture positivity rates remain low (8–15%); nasopharyngeal swab culture data needed to guide empirical therapy
Objective

To determine antibiotic resistance patterns of bacterial pathogens causing community-acquired pneumonia in children under 5 years admitted to a tertiary care hospital in Chennai.

Methods
Design:Prospective observational study
Setting:Paediatric ward, Madras Medical College, Chennai
Period:June 2024 – May 2025
Sample:n = 150 (culture-confirmed CAP cases) — calculated using expected resistance rate 40%, margin 8%
Statistics:Descriptive statistics, Chi-square test for resistance vs clinical severity, MIC interpretation per CLSI guidelines
Key Findings
Streptococcus pneumoniaeDominant pathogen

42% of isolates

Penicillin resistance: 31%

Haemophilus influenzaeBeta-lactamase +

28% of isolates

Ampicillin resistance: 44%

Amoxicillin resistancep = 0.012

Overall 38%

Higher in urban children

Azithromycin resistancep = 0.041

Macrolide 29%

Limited second-line utility

Results

Streptococcus pneumoniae (42%) and Haemophilus influenzae (28%) were the dominant pathogens. Amoxicillin resistance was 38% overall — significantly higher in urban vs rural children (46% vs 27%, p = 0.012). Azithromycin resistance was 29%. Amoxicillin-clavulanate retained sensitivity in 91% of isolates.

Conclusion

High amoxicillin resistance (38%) in CAP pathogens challenges current first-line therapy in our centre. Amoxicillin-clavulanate should replace plain amoxicillin as empirical therapy in hospitalised paediatric CAP. Local antibiogram-guided protocols are urgently needed.

Take-Home Message

4 in 10 CAP pathogens are amoxicillin-resistant in Chennai — time to update local empirical therapy guidelines.

References
  1. 1. WHO. Revised WHO classification and treatment of childhood pneumonia. 2022
  2. 2. IAP CAP Guidelines Committee. Revised IAP recommendations for CAP. Indian Pediatr. 2024;61(3):201

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