Upper respiratory tract infections (URTIs) are among the most common reasons for patient visits to general practice clinics worldwide, accounting for a substantial proportion of outpatient consultations each year (1). These infections include acute pharyngitis, sinusitis, rhinitis, laryngitis, and the common cold. The majority of URTIs are viral in origin and self-limiting, requiring only symptomatic treatment rather than antibiotics (2). However, despite well-established guidelines discouraging routine antibiotic use for viral infections, the overprescription of antibiotics remains a persistent problem in primary care (3).

Inappropriate antibiotic use in URTIs contributes significantly to the global burden of antimicrobial resistance (AMR), which is recognized as a major public health threat (4). Studies have shown that unnecessary antibiotic prescriptions are often driven by physician concerns about patient satisfaction, diagnostic uncertainty, and time constraints during consultations (5). Furthermore, patient expectations and misconceptions regarding the effectiveness of antibiotics also influence prescribing behaviors (6).

Various international and national clinical guidelines, such as those by the World Health Organization (WHO) and the National Institute for Health and Care Excellence (NICE), advocate for restrictive antibiotic prescribing in URTIs and recommend antibiotics only in clearly defined bacterial cases (7,8). Despite these recommendations, surveillance reports suggest that a significant proportion of antibiotic prescriptions in general practice are not aligned with such evidence-based protocols (9).

Monitoring and analyzing antibiotic prescribing patterns in primary care settings are essential for identifying gaps in practice and implementing effective antimicrobial stewardship interventions (10). Understanding current prescribing trends also provides insights into areas where physician training and public education may help in curbing irrational antibiotic use.

This study aims to assess the patterns of antibiotic prescribing for URTIs in general practice clinics and evaluate the appropriateness of prescriptions based on standard treatment guidelines.

Medical records of 500 patients diagnosed with URTIs—including pharyngitis, sinusitis, rhinitis, and laryngitis—were randomly selected using systematic sampling. Patients of all genders aged 18 years and above who consulted during the study period were included. Records lacking clear documentation of diagnosis or treatment were excluded.

Data Collection

A structured data extraction form was used to collect relevant information from patient records. Variables included age, gender, clinical diagnosis, presenting symptoms (such as fever, cough, nasal discharge, sore throat), whether an antibiotic was prescribed, type of antibiotic, and whether the prescription adhered to national or institutional clinical guidelines.

Assessment of Prescription Appropriateness

Antibiotic use was considered appropriate if the prescription met criteria outlined by the Indian Council of Medical Research (ICMR) and WHO guidelines for URTIs—specifically, evidence of bacterial infection or indications such as prolonged fever, purulent nasal discharge, or documented bacterial pharyngitis. All cases were reviewed independently by two experienced general practitioners to determine appropriateness.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS version 26. Descriptive statistics were used to summarize demographics and prescription trends. Categorical variables were presented as frequencies and percentages. The chi-square test was used to evaluate associations between patient characteristics and antibiotic prescribing, with a p-value <0.05 considered statistically significant.

A total of 500 patient records with a diagnosis of upper respiratory tract infections (URTIs) were analyzed. The mean age of the patients was 34.2 ± 12.8 years, with a slight female predominance (56%, n = 280). The most common clinical diagnoses were acute pharyngitis (38%), common cold (28%), and sinusitis (17%).

Table 1: Demographic and Clinical Characteristics of Patients with URTIs (n = 500)

Antibiotics were prescribed in 325 cases (65%), while 175 patients (35%) received only symptomatic treatment. Among those who received antibiotics, amoxicillin was the most frequently prescribed agent (41.5%), followed by azithromycin (26.8%) and cefixime (12.3%). However, only 102 of the antibiotic prescriptions (31.4%) were considered appropriate based on clinical guideline criteria.

Table 2: Antibiotic Prescription Patterns and Appropriateness (n = 500)

Fever and purulent nasal discharge were significantly associated with antibiotic prescriptions (p < 0.05). Patients in the 18–40 age group had a higher rate of antibiotic use (72%) compared to those aged above 50 years (52%), though appropriateness remained inconsistent across age groups (Table 2). These findings suggest a pattern of overprescription, particularly in younger adults presenting with mild symptoms.

This study identified a high rate of antibiotic prescribing (65%) for upper respiratory tract infections (URTIs) in general practice clinics, with only 31.4% of these prescriptions aligning with standard clinical guidelines. These findings raise concerns about the continued inappropriate use of antibiotics for predominantly viral illnesses in outpatient settings, a trend that has been widely documented across different healthcare systems (1,2).

URTIs, including pharyngitis, sinusitis, and the common cold, are most often caused by viral pathogens, for which antibiotics provide no clinical benefit (3,4). Nevertheless, the overuse of antibiotics for such infections remains a persistent challenge in primary care. Similar studies conducted in India and other low- and middle-income countries have reported antibiotic prescribing rates ranging from 50% to 85% for URTIs, despite evidence-based recommendations discouraging such practice (5,6). This overprescription not only exposes patients to unnecessary drug side effects but also contributes significantly to the growing global threat of antimicrobial resistance (AMR) (7,8).

The most commonly prescribed antibiotic in our study was amoxicillin, followed by azithromycin, a pattern consistent with prescribing trends reported in several other regional studies (9,10). While these antibiotics may be effective in select bacterial infections, their indiscriminate use in viral URTIs undermines stewardship efforts and leads to reduced antibiotic efficacy over time (11). Moreover, the frequent use of broad-spectrum antibiotics like azithromycin for self-limiting conditions contributes to resistance development in both community-acquired and hospital-acquired pathogens (12).

In our analysis, symptoms such as fever and purulent nasal discharge were significantly associated with higher prescribing rates, suggesting that physicians may rely heavily on clinical presentation rather than strict diagnostic criteria. While these symptoms can indicate bacterial involvement, they are not definitive indicators and should be interpreted with caution (13). Clinical scoring systems and rapid diagnostic tools, such as rapid strep tests or C-reactive protein (CRP) testing, have been shown to assist in distinguishing bacterial from viral infections and reduce unnecessary antibiotic use (14,15).

This study reveals a high rate of inappropriate antibiotic prescribing for URTIs in general practice, highlighting the urgent need for improved adherence to clinical guidelines. Strengthening antimicrobial stewardship and promoting evidence-based prescribing can help reduce misuse and combat rising antibiotic resistance.

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