Determinants of Antibiotic Prescribing Practices for Acute Respiratory Infections in Children at Tertiary Care Hospitals

Abstract

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.