Background: Pneumonia is a major cause of morbidity and mortality in children under five. Antibiotic treatment must be started immediately in children with pneumonia. The irrational use of antibiotics may increase morbidity and mortality in children with pneumonia. Pneumonia accounted for approximately 16 % of the 5.6 million under-five deaths word wide in 2016. In Uganda, it kills approximately 2,400 children per year. Early diagnosis and appropriate case management with rational use of antibiotics remain the most effective intervention to reduce pneumonia-related mortality. This study aimed at determining antibiotic prescription rationality and associated in-patient treatment outcomes in children aged 2-59 months with severe community-acquired pneumonia at Bwizibwera Health Centre IV from 1st May 2018 to 30th April 2019. Methods: We conducted a retrospective cohort design; data were collected from in-patient records of all children aged 2-59 months with severe community-acquired pneumonia who met the eligibility criteria for a period of one year. Data abstraction template was used for data collection. Health care records of children aged 2-59 months who had other co-morbidities and were on medication that could influence or impact on in-patient treatment outcomes from 1st May 2018 to 30th April 2019 were excluded. Data was entered and analyzed using Epi-info v 7.2 and STATA v 13.0 respectively, Descriptive statistics were reported and Chi-square test was used to compare the proportions.Results: Of the total records of children retrieved and screened (N = 847), 229 prescription records of children fulfilled inclusion criteria, 57 (24.9 %) had rational prescriptions with good outcomes and 172 (75.1 %) had irrational prescriptions with 10 (4.4 %) having unfavorable outcomes. The majority (73.7 %) of those who received rational prescription were on treatment with a combination of benzyl penicillin plus gentamycin while (26.3 %) were on ampicillin plus gentamycin. The majority (32.4 %) of patients with good treatment outcomes were aged 6 – 11 months. This age category also doubled as the group that experienced the highest percentage (40.0 %) of unfavorable outcomes.Conclusion: The majority of children 172 (75.1%) had received irrational antibiotic prescriptions. There were no statistically significant associations between patient characteristics and treatment outcomes.
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