Postgraduate Journal of Pediatrics and Adolescent Medicine

Quality Improvement Initiative to Evaluate and Enhance Antibiotic Prescribing Practices in a Tertiary Care Children's Hospital in India

Savneet Kaur, Kamal Kumar Singhal, Shivani Singh — Fri, 19 Jun 2026 05:14:34 +0000

Background: Infectious diseases remain a significant cause of morbidity and mortality worldwide, and antibiotics play a crucial role in their treatment. However, the inappropriate or irrational use of antibiotics leads to increased healthcare costs, adverse drug effects, and, most critically, the emergence of multidrug-resistant microorganisms, which has become a pressing global concern. To address this issue, we conducted a study at our hospital to evaluate the quality of antibiotic prescribing practices and to enhance the rational use of antibiotics in our pediatric medical unit.

Methods: This study was designed as a time-interrupted, non-randomized controlled trial conducted in a tertiary care children’s hospital in India. Data was collected from patients randomly selected from the Pediatric Outpatient Department (OPD) who were prescribed antibiotics for suspected bacterial infections. Only patients who had not received antibiotics from another health care provider for the current illness were included.

Antibiotic prescriptions were evaluated for adherence to existing guidelines and the quality of the prescription. A multidisciplinary quality improvement team, comprising faculty and residents from the Department of Pediatrics, was established to coordinate this initiative aimed at promoting the appropriate use of antibiotics.

Baseline analysis was done which was found to be sub-standard. Fishbone analysis was done to look for the causes. Plan-Do-Study-Act (PDSA) cycles were planned and conducted to increase the appropriate use of antibiotics. Three cycles were conducted over the period of next three months; which included conducting seminars, poster displays, and the distribution of mobile-friendly guideline documents. Compliance with the policy was tracked biweekly, and adherence to guidelines was recorded and analyzed over three months.

Results: We assessed 50 prescriptions over one month to evaluate the appropriateness of antibiotics prescribed. In the pre-intervention (baseline) phase, only 66.67% of cases adhered to the hospital's antibiotic policy. After collecting baseline data, the first Plan-Do-Study-Act (PDSA) cycle was conducted. Post-PDSA 1, the appropriateness of antibiotic prescriptions improved to 70.13%. However, this fell short of our target. Subsequently, a second PDSA cycle was implemented, following which, the appropriateness of antibiotic prescriptions increased to 94.7%, achieving our target. To assess sustained response PDSA cycle-3 was conducted, which showed remarkable increase of appropriateness to 100% at end of the four weeks.

Conclusions: Quality improvement methods, such as educational interventions, frequent reminders, and regular monitoring, significantly enhanced residents' awareness and improved their antibiotic prescribing practices. Sustained reinforcement and consistent monitoring are essential for the success of quality improvement initiatives and achieving the desired outcomes.

How to cite this article:
Kaur S, Singhal K K, Singh S, Quality Improvement Initiative to Evaluate and Enhance Antibiotic Prescribing Practices in a Tertiary Care Children’s Hospital in India. Postgrad J Pediatr Adol Med. 2026;3(1): 1-6.

Bedside ultrasound in an infant with respiratory distress:clue to congenital malformation

Ahna Ahmed, Hamsika V, Revant Kumar — Fri, 19 Jun 2026 05:19:07 +0000

Lung ultrasound is an effective tool for diagnosing pediatric respiratory conditions. We present a case that highlights the role of bedside lung ultrasound in identifying congenital pulmonary airway malformation in a 3-month-old male presenting with fever and respiratory distress. The initial chest X-ray was inconclusive, but bedside lung ultrasound revealed cystic lung lesions, later confirmed by high-resolution CT. The case underscores the utility of LUS as a rapid, bedside screening tool for congenital lung anomalies. We discuss the advantages of LUS over conventional imaging and its potential role in early CPAM diagnosis.

How to cite this article:
Ahmed A, Hamsika V, Kumar R. Bedside Ultrasound in an Infant With Respiratory Distress: Clue to Congenital Malformation. Postgrad J Pediatr Adol Med. 2026;3(1): 7-9.

The Neonatal Enigma: Unravelling the Mystery of Cola-Coloured Urine

Revant Kumar, Hamsika V, Ahna Ahmed — Fri, 19 Jun 2026 05:23:47 +0000

A 12-hour-old neonate was brought to the pediatrics emergency department with respiratory distress since birth and cola-colored urine noted at admission. The patient had no other bleeding manifestations, and the coagulation profile was normal. POCUS revealed that the umbilical catheter was positioned in the umbilical artery instead of the umbilical vein. The umbilical catheter was immediately removed, and peripheral access was secured. The hematuria resolved over the next twelve hours. The temporal association of the event suggested that the cause of hematuria was inadvertent umbilical artery catheterization leading to renal artery occlusion. Our case highlights the role of POCUS in rapid confirmation of central line position, especially in patients with circulatory collapse.

How to cite this article:
Kumar R, Hamsika V, Ahmed A. The Neonatal Enigma: Unravelling the Mystery of Cola-Coloured Urine. Postgrad J Pediatr Adol Med. 2026;3(1): 10-12.

Accidental Naphthalene Mothball Ingestion Leading to Methemoglobinemia and Severe Intravascular Haemolysis in a 3-Year-Old Girl: A Case Report

Neeta Kaluram Hatkar, Mrinal Bhor — Thu, 02 Jul 2026 05:03:48 +0000

Ingestion of naphthalene-containing mothballs is a well-recognised cause of acquired methaemoglobinemia and haemolytic anaemia in young children, particularly in developing countries. We report a 3-year-old girl who developed profound cyanosis, severe anaemia and haemoglobinuria after unintentional ingestion of mothballs. Admission haemoglobin was critically low, requiring two packed red-cell transfusions, while serial laboratory results confirmed ongoing intravascular haemolysis with elevated indirect bilirubin, reticulocytosis and markedly reduced haptoglobin. Methemoglobinemia was documented during the hospital course, with a measured methaemoglobin level of 8.8%. Intravenous methylene blue (1.5 mg/kg), blood products and supportive care resulted in a complete recovery. This case emphasises distinctive laboratory patterns and the importance of early suspicions of common household toxins among paediatric patients.

How to cite this article:
Hatkar N K, Bhor M S. Accidental Naphthalene Mothball Ingestion Leading to Methemoglobinemia and Severe Intravascular Haemolysis in a 3-Year-Old Girl: A Case Report. Postgrad J Pediatr Adol Med. 2026;3(1): 13-16.