Evaluation of Antibiotic Prescribing Patterns in Patients with Respiratory Tract Infections

Abstract

Introduction: Respiratory tract infections (RTIs) are among the leading causes of healthcare visits and antibiotic prescribing worldwide. Although many RTIs are viral and self-limiting, inappropriate antibiotic use remains common and contributes to antimicrobial resistance, increased healthcare costs, adverse drug events, and poorer clinical outcomes. This study aimed to evaluate antibiotic prescribing patterns, assess the appropriateness of antibiotic prescriptions, and identify factors associated with inappropriate prescribing among patients with respiratory tract infections.

Methodology: A retrospective cross-sectional study was conducted among 422 patients diagnosed with respiratory tract infections at two tertiary care teaching hospitals over a six-month period (January–June 2025). Patient demographics, clinical diagnoses, prescribed antibiotics, dose, route of administration, frequency, duration of therapy, treatment setting, and hospital were extracted from medical records and prescription charts. Prescription appropriateness was evaluated using World Health Organization (WHO) prescribing indicators and evidence-based clinical treatment guidelines based on antibiotic selection, dose, frequency, route, and duration of therapy. Data were analyzed using SPSS version 26.0. Descriptive statistics, Chi-square test, independent-samples t-test, one-way ANOVA, and binary logistic regression were performed. Variables with p <0.20 in bivariate analysis were entered into the multivariable logistic regression model, and both crude and adjusted odds ratios with 95% confidence intervals were reported. Statistical significance was set at p <0.05.

Results: Of the 422 patients included, 216 (51.2%) were recruited from Jinnah International Hospital and 206 (48.8%) from Saidu Teaching Hospital. The mean age was 38.6 ± 17.4 years, and 55.2% were male. Upper respiratory tract infections accounted for 58.5% of cases, while lower respiratory tract infections accounted for 41.5%. A total of 587 antibiotics were prescribed, with cephalosporins (34.6%), penicillins (26.7%), and macrolides (18.4%) being the most frequently prescribed classes. Overall, 71.6% of prescriptions were appropriate, whereas 28.4% were inappropriate. The most common reasons for inappropriate prescribing were antibiotic use for likely viral infections (42.5%), inappropriate antibiotic selection (27.5%), incorrect dose (18.3%), and inappropriate treatment duration (11.7%). Multivariable logistic regression identified lower respiratory tract infection (AOR = 2.12, 95% CI: 1.34–3.36; p = 0.001), inpatient status (AOR = 1.89, 95% CI: 1.18–3.02; p = 0.008), and age >60 years (AOR = 1.67, 95% CI: 1.04–2.69; p = 0.034) as independent predictors of inappropriate antibiotic prescribing.

Conclusion: Although most antibiotic prescriptions adhered to evidence-based treatment guidelines, inappropriate prescribing remained common, particularly due to unnecessary antibiotic use for presumed viral respiratory tract infections and inappropriate empirical use of broad-spectrum agents. Strengthening antimicrobial stewardship, promoting adherence to clinical practice guidelines, and implementing regular prescription audits are essential to optimize antibiotic use and reduce the growing burden of antimicrobial resistance.