Prescribing patterns of antimicrobial therapy in respiratory tract infections at a tertiary care teaching hospital: a prospective study.

Respiratory tract infections (RTIs) are among the most common causes of hospital admissions and antibiotic use worldwide, and inappropriate antimicrobial prescribing in such cases significantly contributes to the growing problem of antimicrobial resistance, particularly in tertiary care settings. This prospective observational study was conducted in the Departments of General Medicine and Respiratory Medicine at a tertiary care teaching hospital from March to May 2026 and included 113 adult inpatients (≥18 years) diagnosed with upper or lower RTIs and receiving at least one antimicrobial agent. Data were collected from case records and analyzed using WHO prescribing indicators along with descriptive statistics. The average number of antibiotics prescribed per patient was 1.7. Injectable formulations were predominantly used, accounting for 88% of prescriptions, while oral therapy constituted only 12%. Generic prescribing was observed in 72% of cases, and the mean duration of antimicrobial therapy was 6.2 days. Upper RTIs were the most common diagnosis (42.48%), followed by community-acquired pneumonia (26.55%). Ceftriaxone emerged as the most frequently prescribed antibiotic, used as monotherapy in 26.5% of patients and in combination with azithromycin in 19.5% of cases. A high proportion of prescriptions involved broad-spectrum "Watch" category antibiotics, including piperacillin-tazobactam and meropenem, whereas the use of "Access" antibiotics was relatively limited. Intravenous-to-oral switch therapy was also found to be underutilized. Overall, the study highlights a strong reliance on broad-spectrum and injectable antibiotics in the management of RTIs, with suboptimal utilization of Access-category agents. Although prescribing practices were broadly consistent with guideline recommendations for more severe infections, the excessive use of Watch and Reserve antibiotics indicates a need for stronger antimicrobial stewardship interventions. Enhancing culture-guided therapy, promoting intravenous-to-oral switch strategies, encouraging generic prescribing, and strengthening institutional antimicrobial stewardship programs are essential measures to optimize antibiotic use and help curb antimicrobial resistance in tertiary care settings.