Patterns of irrational drug use in pediatric acute respiratory infections: A hospital- based cross- sectional study in South India

Abstract Background and Purpose: Irrational drug use is a growing public health concern, with the World Health Organization estimating that 50% of prescriptions worldwide are irrational. Data on rational drug prescriptions for acute respiratory infections (ARIs) in children are limited. Methods: Children under 14 years of age with ARIs visiting a tertiary care hospital in South India were enrolled. Data on prescriptions, demographics, and clinical information were collected and analyzed. Results: A total of 156 children (median age: 2 years, 53.8% male) were enrolled. The most common ARI was upper respiratory tract infection (65.3%), followed by viral bronchiolitis/pneumonia (22.3%). Of 262 prescriptions, 86.2% were written by physicians, and 13.7% were self-prescribed. The median number of drugs per child was 3 (range: 2–5). Antibiotics were included in 58.8% of physician prescriptions (97.7% irrational), and 61.9% included cough medications (65.7% irrational). A viral pathogen was detected in 35% of children who received antibiotics. Commonly prescribed antibiotics were cephalosporins and amoxicillin–clavulanate, while cough syrups included chlorpheniramine–phenylephrine, levosalbutamol, ambroxol, and guaifenesin. Only 12.3% of prescriptions used generic drug names, and polypharmacy (≥2 medications) was found in 81.4% of prescriptions. Presence of sore throat and respiratory distress were associated with antibiotic prescription by physicians. Conclusion: This study highlights a high prevalence of irrational drug use in children with ARIs, with inappropriate antibiotic and cough medication prescriptions. There is a need for better prescribing practices, diagnostic accuracy, and adherence to evidence-based guidelines.