Objective: This study aimed to assess cephalosporin prescribing patterns, clinical appropriateness, susceptibility and resistance profiles, potential drug–drug interactions, and de-escalation practices in the management of infectious diseases. Methods: This prospective observational study was conducted over 6 months (May–October 2024) at a tertiary care hospital in South India. A total of 288 adult patients (>18 years) who received at least one cephalosporin prescription were included. Relevant demographic, clinical, and prescription data were collected from the patient case records. The appropriateness of antimicrobial therapy was evaluated according to the Indian Council of Medical Research antimicrobial stewardship guidelines. Data were entered into Microsoft Excel and analyzed using IBM SPSS Statistics version 20.0. Findings: Among the 288 patients, 383 cephalosporin prescriptions were documented. Culture testing was performed in 63% ( n = 181) of cases; however, only 13.9% ( n = 40) showed positive microbial growth. Escherichia coli was the most frequently isolated organism, accounting for 30% ( n = 12) of culture-positive cases. Guideline-based evaluation revealed that 32.4% of cephalosporin prescriptions were inappropriate, indicating a significant deviation from evidence-based practice. Conclusion: Third-generation cephalosporins were predominantly prescribed in the study population. Although cephalosporins remain important and accessible therapeutic agents, inappropriate and empirical prescribing practices contribute to the rising antimicrobial resistance. Rational use guided by culture sensitivity results and antimicrobial stewardship principles is essential to preserve their clinical efficacy and limit further resistance.
Pavithra et al. (2026) studied this question.