Antibiotic prescribing practice for pediatric respiratory tract infections in a tertiary care hospital in Iraq

Prescribing antibiotics for pediatric patients with respiratory tract infections (RTIs) remains poorly studied in many low- and middle-income countries. This study aims to evaluate the quality of antibiotic prescribing for in-hospital pediatric patients with RTIs, identify predictors of this practice, and evaluate patients’ clinical outcomes. A cross-sectional study was conducted at Baghdad Medical City from September 2025 to January 2026. Pediatric inpatients were selected using consecutive sampling, and data were collected from their medical records. Antibiotics were prescribed in 81.0% of cases, mostly cephalosporins (43.8%) and penicillins (34.6%). The intravenous (IV) route of administration was prescribed in 84.0% of cases. Prescribing quality was moderate (mean = 6.12 + 1.24). Antibiotics were prescribed for viral infections in 29.5% of cases (59 out of 200 patients); weight-based dosing was not documented in 27.3% of cases; and 7.1% of cases had a microbiological test performed. A longer hospital stay ( β = -0.18, P 0.001) and the use of IV antibiotics (β = - 0.72, P = 0.004) were the only independent variables associated with lower prescribing quality. Most pediatric patients (94.5%) achieved successful treatment, with few adverse events (1.0%) and readmissions (3.5%). Despite the positive short-term clinical outcomes, significant shortcomings in diagnostic and prescribing practices remain.