Background: Antimicrobial resistance is a global crisis that threatens to reverse a century of medical progress; threatening the effective prevention and treatment of common infectious diseases. Objectives: To evaluate the current practices of antimicrobial utilization and clinical outcomes of children with pneumonia admitted to Jimma Medical Center, Ethiopia. Method: A prospective observational study design was conducted on children admitted to the pediatric wards of Jimma Medical Center. The study was conducted from February 03, 2022, to June 03, 2022, and patients aged < 18 years and diagnosed with pneumonia were included. A chart review supplemented by a self-administered questionnaire was used to collect data. Descriptive statistics and binary logistic regressions were performed for data analyses. Results: Among the total of 146 patients, 61.6% were male, and the mean age was 40.95 (+47.61) months. Microbiologically and radiologically examined patients were 47(32.19%) and 64 (43.8%), respectively.  All the treatment approaches were found to be initiated empirically. Ceftriaxone was the most commonly prescribed antimicrobial. In-hospital mortality was 7.5%. Pre-admission antimicrobial use (AOR =3.87; 95% CI:1.34-11.16; P=0.012), antimicrobial change (AOR = 3.74; 95% CI: 1.522-9.22; P=0.004), and hospital stay (> 10 days) (AOR = 6.00; 95% CI: 2.53-14.22; P=0.029) were all independent predictors of poor clinical outcome. Conclusion: An empirically initiated antimicrobial was completed without sufficient evidence of indication, such as microbiological and radiographic findings. More than one-fourth of the patients treated for pneumonia experienced poor outcomes, implicating the need for more attention during treatment.

The authors have declared no competing interest.

Yes

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study involves human participants and the study was conducted from February 03, 2022, to June 03, 2022, in the pediatric ward of Jimma Medical Center. The proposal, including Amharic and Oromic written informed consent, which is attached as an annex, was submitted to the School of Pharmacy, Jimma University Institutional Review Board for review and approval. The study was conducted after securing the letter of ethical approval (Ref. No. JUIRB016/14) from the Jimma University Institutional Review Board. A formal letter was written to Jimma Medical Center (Ref. No.ፋ/ት/በት133/2014/) and, the hospital medical director and head of the department of pediatric ward were informed about the purpose of the study to get permission and cooperation. Written informed consent from the child's parent or guardian was obtained after providing information regarding the purpose/nature of the study. parent or guardian was told the reasons for their child being selected to be included in the study and assured that declining participation would not have any influence on the right of their child to get treatment. parent or guardian was also told about the right to withdraw from the study at any time. The parent or guardian was assured of confidentiality (privacy and anonymity) of the information obtained during the study.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All relevant data are within the manuscript and its supporting information files.