{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T08:16:49Z","timestamp":1788423409894,"version":"build-2803163510"},"reference-count":29,"publisher":"PAGEPress Publications","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Monaldi Arch Chest Dis"],"abstract":"<jats:p>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 (\u226518 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 \u201cWatch\u201d category antibiotics, including piperacillin-tazobactam and meropenem, whereas the use of \u201cAccess\u201d 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.<\/jats:p>","DOI":"10.4081\/monaldi.2026.4118","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T08:07:29Z","timestamp":1788422849000},"source":"Crossref","is-referenced-by-count":0,"title":["Prescribing patterns of antimicrobial therapy in respiratory tract infections at a tertiary care teaching hospital: a prospective study"],"prefix":"10.4081","author":[{"given":"Mandati Santhosh","family":"Reddy","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, KLE College of Pharmacy, Belagavi, KLE Academy of Higher Education and Research, Karnataka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaishnavi Jotiba","family":"Gurav","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, KLE College of Pharmacy, Belagavi, KLE Academy of Higher Education and Research, Karnataka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyoti A","family":"Hanamgond","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, KLE College of Pharmacy, Belagavi, KLE Academy of Higher Education and Research, Karnataka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anasuya","family":"Vannur","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, KLE College of Pharmacy, Belagavi, KLE Academy of Higher Education and Research, Karnataka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alika V","family":"Martins","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, KLE College of Pharmacy, Belagavi, KLE Academy of Higher Education and Research, Karnataka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradnya","family":"Rajmane","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, KLE College of Pharmacy, Belagavi, KLE Academy of Higher Education and Research, Karnataka"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"86256","doi-asserted-by":"crossref","unstructured":"Beg MA, Dutta SB, Bawa S, et al. Prescribing trends in respiratory tract infections in a tertiary care teaching hospital. Int J Res Med Sci 2017;5:2588-91.","DOI":"10.18203\/2320-6012.ijrms20172452"},{"key":"86257","doi-asserted-by":"crossref","unstructured":"Gupta CN, Chatterjee K. Prescription pattern of antibiotics in respiratory disorders in a tertiary care teaching hospital in Eastern part of India. Int J Res Med Sci 2017;5:1430-3.","DOI":"10.18203\/2320-6012.ijrms20171240"},{"key":"86258","doi-asserted-by":"crossref","unstructured":"Naveen A, Sravani MR. Study of drug utilization trends in respiratory tract infections in a tertiary care teaching hospital: a retrospective study. Int J Basic Clin Pharmacol 2017;6:2583-6.","DOI":"10.18203\/2319-2003.ijbcp20174635"},{"key":"86259","doi-asserted-by":"crossref","unstructured":"Srikanth S, Mohapatra S, Tharunya P, Rani RJ. Prescribing pattern of antibiotics and susceptibility of pathogens in upper respiratory tract infections: a study from a tertiary care hospital. Int J Res Med Sci 2020;8:1221-5.","DOI":"10.18203\/2320-6012.ijrms20201027"},{"key":"86260","doi-asserted-by":"crossref","unstructured":"Prasad A, Mukherjee S, Era N, Mukherjee M. Antibiotic susceptibility pattern of bacteria isolated from patients of respiratory tract infection in a tertiary care hospital of Eastern India. Int J Basic Clin Pharmacol 2019;8:757-61.","DOI":"10.18203\/2319-2003.ijbcp20191112"},{"key":"86261","doi-asserted-by":"crossref","unstructured":"Kokani VR, Pandit PR, Bhave KA. Antimicrobial prescribing pattern in the treatment of acute respiratory tract infections in children in a tertiary care hospital. Int J Basic Clin Pharmacol 2016;5:1770-4.","DOI":"10.18203\/2319-2003.ijbcp20163152"},{"key":"86262","doi-asserted-by":"crossref","unstructured":"Raju RN. Across-sectional observational study on drug utilization and prescribing patterns of antibiotics in lower respiratory tract infections in tertiary care teaching hospital. AJP 2024;18910-3.","DOI":"10.22377\/ajp.v18i3.5642"},{"key":"86263","doi-asserted-by":"crossref","unstructured":"Merli M, D\u2019Amico F, Travi G, Puoti M. Current state of antimicrobial treatment of lower respiratory tract infections due to Carbapenem-resistant Acinetobacter baumannii. Future Pharmacol 2023;3:473-87.","DOI":"10.3390\/futurepharmacol3020030"},{"key":"86264","doi-asserted-by":"crossref","unstructured":"Gupta N, Singarapu S, Ahmed MI, et al. An ambispective observational study on antibiotics in pulmonology department in a tertiary care hospital. Int J Community Med Public Health 2024;11:1608-11.","DOI":"10.18203\/2394-6040.ijcmph20240898"},{"key":"86265","doi-asserted-by":"crossref","unstructured":"Kumar RN, Selva P. Analysis of prescription pattern of antibiotics among patients with respiratory tract infections at a tertiary care hospital. Biomed Pharmacol J 2019;12:1595-602.","DOI":"10.13005\/bpj\/1790"},{"key":"86266","doi-asserted-by":"crossref","unstructured":"Kebede GE, Cosh SM, Humphries J, Islam MS. Antimicrobial prescription pattern and appropriateness for respiratory tract infection in outpatients: a systematic review and meta-analysis. Syst Rev 2024;13:229.","DOI":"10.1186\/s13643-024-02649-3"},{"key":"86267","unstructured":"Rearigh L. Infectious Diseases Society of America Community-Acquired Pneumonia Clinical Pathway Overview. 2023. Available from: https:\/\/asap.nebraskamed.com\/2023\/11\/23\/infectious-diseases-society-of-america-community-acquired-pneumonia-clinical-pathway-overview\/."},{"key":"86268","doi-asserted-by":"crossref","unstructured":"Shrivastava S, Mothsara C, Shafiq N, et al. Antimicrobial prescription patterns in tertiary care centres in India: a multicentric point prevalence survey. EClinicalMedicine 2025;82:103175.","DOI":"10.1016\/j.eclinm.2025.103175"},{"key":"86269","doi-asserted-by":"crossref","unstructured":"Garg R, Wankhade AB, Banerjee T. Point prevalence study of antibiotic appropriateness and economical cost in a tertiary care trauma hospital of Northern India. Open Forum Infect Dis 2025;12:ofae631.1927.","DOI":"10.1093\/ofid\/ofae631.1927"},{"key":"86270","doi-asserted-by":"crossref","unstructured":"Ravi G, Chikara G, Bandyopadhyay A, Handu S. A prospective study to evaluate antimicrobial prescribing pattern among admitted patients in hilly Himalayan region of northern India. J Family Med Prim Care 2021;10:1607-13.","DOI":"10.4103\/jfmpc.jfmpc_1230_20"},{"key":"86271","doi-asserted-by":"crossref","unstructured":"Priyadharsini RP, Ramasamy K, Amarendar S. Antibiotic-prescribing pattern in the outpatient departments using the WHO prescribing indicators and AWaRe assessment tool in a tertiary-care hospital in South India. J Family Med Prim Care 2022;11:74-8.","DOI":"10.4103\/jfmpc.jfmpc_527_21"},{"key":"86272","doi-asserted-by":"crossref","unstructured":"Nazir T, Ashai Z, Tabassum R, Ayoub I. Prescription pattern of antibiotics in hospital discharge summaries of a tertiary care hospital in India: a cross-sectional study. Int J Basic Clin Pharmacol 2026;15:112-8.","DOI":"10.18203\/2319-2003.ijbcp20254161"},{"key":"86273","unstructured":"Indian Council of Medical Research. Antimicrobial Stewardship Programme (AMSP) in Hospitals. Available from: https:\/\/www.icmr.gov.in\/icmrobject\/custom_data\/pdf\/resource-guidelines\/AMSP_0.pdf"},{"key":"86274","doi-asserted-by":"crossref","unstructured":"Harvey EJ, McLeod M, De Br\u00fan C, Ashiru-Oredope D. Criteria to achieve safe antimicrobial intravenous-to-oral switch in hospitalised adult populations: a systematic rapid review. 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World Health Organization AWaRe framework for antibiotic stewardship: where are we now? Antimicrob Stewardship Healthc Epidemiol 2023;3:e84.","DOI":"10.1017\/ash.2023.164"},{"key":"86279","doi-asserted-by":"crossref","unstructured":"Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by IDSA and ATS. Clin Infect Dis 2016;63:e61-111.","DOI":"10.1093\/cid\/ciw353"},{"key":"86280","doi-asserted-by":"crossref","unstructured":"Tomczyk S, Jain S, Bramley AM, et al. Antibiotic prescribing for adults hospitalized in the etiology of pneumonia in the community study. Open Forum Infect Dis 2017;4:ofx088.","DOI":"10.1093\/ofid\/ofx088"},{"key":"86281","doi-asserted-by":"crossref","unstructured":"Zehra A, Ansari T, Muttaqi Shah SSA, et al. Antibiotic stewardship benchmarking-Using the WHO point prevalence survey of antimicrobial prescribing in a Tertiary Care Public Hospital, Karachi. 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