Antibiotic Prescribing Patterns and Factors Associated With Inappropriate Use in Acute Upper Respiratory and Ear, Nose, and Throat Infections: A Prospective Observational Study

Objectives: The aim of this study was to describe antibiotic prescribing patterns and identify factors associated with inappropriate antibiotic use among adults presenting with acute upper respiratory tract and ear, nose, and throat (ENT) infections. Methods: This prospective observational study was conducted in the department of otorhinolaryngology at a healthcare institution in Hyderabad, India, between March 2025 and January 2026. A total of 100 adult patients with acute upper respiratory tract and ENT infections were included. Antibiotic prescribing frequency, selection of antimicrobial agents, treatment duration, and appropriateness of prescriptions were evaluated. Associations between selected clinical characteristics and inappropriate antibiotic prescribing were assessed using two-sided Fisher’s exact tests. Results: The mean age of the study participants was 34.6±13.2 years, and 54.0% were male. Antibiotics were prescribed to 72 patients (72.0%), including 18 of 30 patients (60.0%) diagnosed with common cold or acute viral nasopharyngitis. Amoxicillin–clavulanate (36.1%) and azithromycin (27.8%) were the most frequently prescribed antibiotics. Among the 72 antibiotic prescriptions, 40 (55.6%) were classified as inappropriate, representing 40.0% of all consultations. The absence of an appropriate clinical indication accounted for 26 (65.0%) of these inappropriate prescriptions. Inappropriate antibiotic prescribing was significantly more frequent among patients presenting within 3 days of symptom onset (72.2% vs. 38.9%; p=0.009), those without documented fever (68.2% vs. 35.7%; p=0.008), and those requesting antibiotics (78.6% vs. 40.9%; p=0.003). Conclusion: The study identified a high frequency of antibiotic prescribing and a substantial proportion of inappropriate prescriptions among adults with acute upper respiratory tract and ENT infections. Shorter symptom duration, absence of documented fever, and patient requests for antibiotics were significantly associated with inappropriate prescribing. These findings highlight the importance of evidence-based prescribing, improved clinical documentation, patient education, and antimicrobial stewardship interventions to promote rational antibiotic use and reduce unnecessary antimicrobial exposure.