Determinants of Antibiotic Prescribing Practices for Acute Respiratory Infections in Children at Tertiary Care Hospitals
DOI:
https://doi.org/10.65761/pjcr.2026.292Keywords:
Inappropriate Prescribing, Anti-Bacterial Agents, Practice Patterns, Physicians', Respiratory Tract Infections, Child, Hospitals, TertiaryAbstract
Background: N Acute respiratory infections (ARIs) are a major cause of childhood morbidity, while inappropriate antibiotic use contributes to antimicrobial resistance. To assess antibiotic prescribing practices and identify clinical, patient-related, physician-related, institutional, and diagnostic determinants of inappropriate prescribing among children with ARIs.
Methods: A hospital-based analytical cross-sectional study was conducted among 423 children aged 1 month to 12 years at selected tertiary-care hospitals in Punjab, Pakistan. Data were collected prospectively using a structured questionnaire and clinical-record abstraction form and analyzed using IBM SPSS Statistics 29. Descriptive statistics, chi-square/Fisher’s exact tests, and binary logistic regression were applied, with significance set at p < 0.05.
Results: Antibiotics were prescribed to 318 (75.2%) children, with 201 (63.2%) prescriptions classified as appropriate and 117 (36.8%) as inappropriate. Significant associations were observed with previous antibiotic exposure, comorbidity, disease severity, clinical diagnosis, guideline awareness, antimicrobial-stewardship training, and prescribing barriers. Regression analysis showed increased inappropriate prescribing where antibiotic guidelines were unavailable (AOR = 1.82), stewardship programs were absent (AOR = 2.14), diagnostic facilities were inadequate (AOR = 1.76), laboratory support was limited (AOR = 1.91), diagnostic testing was not performed (AOR = 2.03), and clinical diagnostic uncertainty was high (AOR = 2.21).
Conclusion: Inappropriate antibiotic prescribing was substantial and was influenced by clinical, physician-related, institutional, and diagnostic factors, highlighting the need for stronger stewardship programs, prescribing guidelines, diagnostic facilities, and physician training.
References
1. Abubakar FI, Ahmed HK, Akintunde OO, Rufai IA. Pattern and appropriateness of antibiotic therapy for acute respiratory tract infection among under-five children accessing care in a tertiary facility, Sokoto, Nigeria. BMJ Paediatr Open. 2025;9(1). doi:10.1136/bmjpo-2025-003468.
2. Akkawi ME, Taffour RM, Al-Shami AM. Evaluation of antibiotic prescribing pattern and appropriateness among hospitalized pediatric patients: findings from a Malaysian teaching hospital. Infect Dis Rep. 2022;14(6):889-899. doi:10.3390/idr14060089.
3. Alekaw H, Derebe D, Melese WM, Yismaw MB. Antibiotic prescription pattern, appropriateness, and associated factors in patients admitted to pediatric wards of Tibebe Ghion Specialized Hospital, Bahir Dar, North West Ethiopia. Infect Drug Resist. 2022:6659-6669. doi:10.2147/IDR.S380897.
4. Al-Khazzan AY, Doa'a AI, Halboup AM, Harun SN, Al Dhubai S, Hayal N, et al. Determinants of antibiotic prescribing for upper respiratory tract infections in Sana’a City, Yemen. Univ Sci Technol J Med Sci. 2024;2. doi:10.59222/ustjms.2.2.a5.
5. Bezie MM, Asmare ZA, Asebe HA, Lombebo AA, Fentie BM, Asnake AA, et al. Factors associated with the use of antibiotics for children presenting with illnesses with fever and cough obtained from prescription and non-prescription sources: a cross-sectional study of data for 37 sub-Saharan African countries. BMC Public Health. 2024;24(1):1089. doi:10.1186/s12889-024-18490-1.
6. Chan YY, Ibrahim MB, Wong CM, Ooi CK, Chow A. Determinants of antibiotic prescribing for upper respiratory tract infections in an emergency department with good primary care access: a qualitative analysis. Epidemiol Infect. 2019;147. doi:10.1017/S095026881800331X.
7. Covino M, Buonsenso D, Gatto A, Morello R, Curatole A, Simeoni B, et al. Determinants of antibiotic prescriptions in a large cohort of children discharged from a pediatric emergency department. Eur J Pediatr. 2022;181(5):2017-2030. doi:10.1007/s00431-022-04386-y.
8. Dorta HG, Nandi A. Patterns of antibiotic use for acute respiratory infections in under-three-year-old children in India: a cross-sectional study. J Glob Health. 2023;13:04159. doi:10.7189/jogh.13.04159.
9. Ghimire P, Gachhadar R, Piya N, Shrestha K, Shrestha K. Prevalence and factors associated with acute respiratory infection among under-five children in selected tertiary hospitals of Kathmandu Valley. PLoS One. 2022;17(4). doi:10.1371/journal.pone.0265933.
10. Gotta V, Baumann P, Ritz N, Fuchs A, Baer G, Bonhoeffer JM, et al. Drivers of antibiotic prescribing in children and adolescents with febrile lower respiratory tract infections. PLoS One. 2017;12(9). doi:10.1371/journal.pone.0185197.
11. Iftikhar S, Sarwar MR, Saqib A, Sarfraz M, Shoaib QUA. Antibiotic prescribing practices and errors among hospitalized pediatric patients suffering from acute respiratory tract infections: a multicenter, cross-sectional study in Pakistan. Medicina (Kaunas). 2019;55(2):44. doi:10.3390/medicina55020044.
12. Igirikwayo ZK, Byamugisha E, Kabakyenga J. Factors influencing antibiotic prescription for respiratory tract infections among prescribers in Jinja City, Uganda: a qualitative study. BMC Pulm Med. 2026;26(1):44. doi:10.1186/s12890-025-04085-y.
13. Kasse GE, Cosh SM, Humphries J, Islam MS. Pattern and appropriateness of antimicrobial prescription for acute respiratory tract infection in primary healthcare settings in Ethiopia. Antimicrob Resist Infect Control. 2025;14(1):110. doi:10.1186/s13756-025-01612-8.
14. Kern WV, Kostev K. Prevalence of and factors associated with antibiotic prescriptions in patients with acute lower and upper respiratory tract infections—a case-control study. Antibiotics (Basel). 2021;10(4):455. doi:10.3390/antibiotics10040455.
15. Lanyero H, Eriksen J, Obua C, Stålsby Lundborg C, Nanzigu S, Katureebe A, et al. Use of antibacterials in the management of symptoms of acute respiratory tract infections among children under five years in Gulu, northern Uganda: prevalence and determinants. PLoS One. 2020;15(6). doi:10.1371/journal.pone.0235164.
16. Lim DW, Htun HL, Ong LS, Guo H, Chow A. Systematic review of determinants influencing antibiotic prescribing for uncomplicated acute respiratory tract infections in adult patients at the emergency department. Infect Control Hosp Epidemiol. 2022;43(3):366-375. doi:10.1017/ice.2020.1245.
17. Mathew R, Sayyed H, Behera S, Maleki K, Pawar S. Evaluation of antibiotic prescribing pattern in pediatrics in a tertiary care hospital. Avicenna J Med. 2021;11(1):15-19. doi:10.4103/ajm.ajm_73_20.
18. Medrano PG, Weerasinghe N, Nagahawatte A, Vanderburg S, Park LP, Wijayaratne GB, et al. Prevalence and predictors of antibiotic prescription among patients hospitalized with viral lower respiratory tract infections in Southern Province, Sri Lanka. PLoS One. 2024;19(6). doi:10.1371/journal.pone.0304690.
19. O’Connor R, O’Doherty J, O’Regan A, Dunne C. Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review. Ir J Med Sci. 2018;187(4):969-986. doi:10.1007/s11845-018-1774-5.
20. Otuko R, Maina M, Mwaniki P, Mweu M, Akech S. Patterns and determinants of antibiotic prescription among children admitted to public hospitals in Kenya: a cross-sectional observational study. Wellcome Open Res. 2023;8:454. doi:10.12688/wellcomeopenres.19531.1.
21. Sulaiman A, Isah MA, Usman A. An assessment of the index of rational drug prescribing for severe acute respiratory infections among hospitalised children in Northern Nigeria: a retrospective study. Expert Rev Anti Infect Ther. 2024;22(6):479-486. doi:10.1080/14787210.2024.2307913.
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Copyright (c) 2026 Muhammad Danyal, Samina Habib, Muhammad Zian Shakir, Ijaz ul Haq, Jumana Issa Khair Alla Taha, Muhammad Usman Mehmood, Shoaib Abdul Rahim
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