Inappropriate antibiotic use in upper respiratory tract infections: prevalence and predictors from an outpatient cohort

Objectives Upper respiratory tract infections (URTIs) are among the most common reasons for outpatient visits, yet the majority are viral in origin and do not require antibiotics. Inappropriate antibiotic consumption contributes to antimicrobial resistance, a major global health threat. This study aimed to assess the prevalence and predictors of inappropriate antibiotic use among URTI patients in a tertiary hospital setting. Methods A cross-sectional study was conducted in the outpatient departments of Alkhidmat Raazi Hospital, Rawalpindi, from December 2024 to February 2025. A total of 384 patients presenting with URTI symptoms were enrolled using convenience sampling. Data on demographics, presenting complaints, prior and current antibiotic use, and prescribing sources were collected through a structured questionnaire. Descriptive statistics and logistic regression were performed using SPSS v25. Results Of 384 patients, 43.8 % (n=168) reported prior antibiotic use, most commonly azithromycin (51.2 %). Notably, 89 % of antibiotics belonged to the WHO Watch group. Only 9.6 % of patients were clinically assessed as requiring antibiotics, highlighting a major gap between actual need and consumption. Predictors of clinician-prescribed antibiotics included older age, higher temperature, and longer fever duration. Self-medication was significantly associated with female gender, previous antibiotic use, and prolonged fever. Over 80 % of antibiotics were initiated without qualified medical advice. Conclusions Nearly half of URTI patients reported inappropriate antibiotic use, predominantly self-medication or advice from unqualified providers. Despite limited clinical indications, broad-spectrum agents from the Watch group were widely consumed. These findings underscore the urgent need for targeted antimicrobial stewardship programs and stronger regulatory policies to promote rational antibiotic use and combat antimicrobial resistance in outpatient settings.