Compliance of Antibiotic Prescribing with Clinical Guidelines in the Management of Respiratory Infections Among Children Aged 1–14 Years: A Retrospective Study in Primary Health Care

Background: Optimizing antibiotic prescribing for pediatric respiratory tract infections requires assessment of indication, antimicrobial selection, weight-adjusted dose, and treatment duration. This study evaluated guideline compliance and factors associated with non-compliance among children managed in primary health care. Methods: This retrospective observational analytical study included 600 respiratory infection episodes among children aged 1–14 years managed between 5 January and 30 June 2026. Prescribing was evaluated according to indication, antimicrobial selection, dose, and duration. Antibiotics were additionally characterized by WHO AWaRe category and antibacterial spectrum. Logistic regression was used to identify factors associated with overall guideline non-compliance. Results: Antibiotics were prescribed in 363/600 episodes (60.5%), while 308/600 (51.3%) met all applicable criteria for overall compliance. Indication was appropriate in 80.8% of episodes. Among antibiotic-treated episodes, selection was appropriate in 41.9%, dose in 78.5%, and duration in 79.3%; 41.6% of prescriptions were Watch antibiotics and 62.0% were broad-spectrum. Overall non-compliance affected 94.0% of Watch prescriptions compared with 52.8% of Access prescriptions (p < 0.001). Non-compliance was highest in community-acquired pneumonia (67.1%), acute bacterial sinusitis (62.7%), and acute tonsillopharyngitis (58.9%). Compared with acute bronchitis, adjusted odds of non-compliance were higher for acute otitis media (AOR 1.87, 95% CI 1.05–3.31), acute tonsillopharyngitis (AOR 3.21, 95% CI 1.79–5.76), and community-acquired pneumonia (AOR 3.86, 95% CI 1.64–9.09). Conclusions: Overall guideline compliance was 51.3% despite substantially higher indication appropriateness. Antimicrobial selection represented the principal prescribing dimension requiring improvement, with marked diagnosis-specific variation. The particularly high non-compliance among Watch prescriptions highlights the need for targeted review of antibiotic selection. Diagnosis-specific assessment alongside AWaRe classification, antibacterial spectrum, dose, and duration may strengthen antimicrobial stewardship in pediatric primary care.