A Comparative Analysis of Cephalosporins, Macrolides and Fluoroquinolones in the Management of Respiratory Infection: Prescription Trends and Clinical Outcomes

Respiratory tract infections (RTIs) are among the leading causes of morbidity worldwide, necessitating effective antibiotic therapy. This study compares cephalosporins, macrolides, and fluoroquinolones in terms of prescription trends, clinical efficacy, cost-effectiveness, and adverse effects at Ayub Teaching Hospital, Abbottabad. A retrospective observational study was conducted on 1,000 RTI patients. Prescription trends, recovery rates, adverse effects, and cost-effectiveness were analyzed using statistical tools, including ANOVA, chi-square tests, and logistic regression. Clinical efficacy was assessed based on symptom resolution and recovery time. Cost-effectiveness was determined by the price per treatment cycle, while adverse effects were compared across drug classes. Macrolides were the most prescribed class (42.5%), followed by cephalosporins (35.2%) and fluoroquinolones (22.3%). Macrolides demonstrated the highest clinical efficacy, with a mean recovery time of 5.8 ± 1.2 days compared to 6.9 ± 1.5 days for cephalosporins and 7.3 ± 1.8 days for fluoroquinolones (p < 0.05). Logistic regression analysis revealed that macrolides had a 1.7 times higher likelihood of complete recovery compared to fluoroquinolones (OR = 1.7, 95% CI: 1.3-2.2, p = 0.002). Adverse effects were significantly lower in macrolides (8.4%) compared to fluoroquinolones (19.7%) and cephalosporins (14.9%) (p < 0.01). Cost-effectiveness analysis showed macrolides as the most affordable option, with an average treatment cost of PKR 450 ± 50, compared to PKR 750 ± 80 for cephalosporins and PKR 1,150 ± 90 for fluoroquinolones. Healthcare resource utilization was significantly lower with macrolides, with ICU admission rates of 5.3% compared to 10.2% for cephalosporins and 14.8% for fluoroquinolones (p < 0.001). Macrolides emerged as the most effective and cost-efficient antibiotic class for RTI management, demonstrating superior clinical efficacy, fewer adverse effects, and lower healthcare costs. Cephalosporins were moderately effective but more expensive, while fluoroquinolones, despite their broad spectrum, had the highest adverse effects and cost. Given these findings, macrolides should be prioritized for RTI treatment in clinical settings.