Background: Lower respiratory tract infections are among the most frequent causes of antibiotic use in routine clinical practice. Inappropriate selection, unnecessary combinations, excessive parenteral use, and poor microbiological guidance contribute to antimicrobial resistance and irrational drug utilization.

Objectives: To evaluate antibiotic prescribing practices in patients with lower respiratory tract infections and to assess selected drug utilization indicators, including prescribing pattern, route, duration, culture-guided therapy, generic prescribing, essential medicines list use, and guideline concordance.

Methods: This hospital-based cross-sectional observational study was conducted on one hundred adult patients diagnosed with lower respiratory tract infections were included. Data on demographic profile, diagnosis, comorbidities, symptoms, antibiotic prescriptions, microbiological testing, and prescription indicators were recorded in a structured proforma and analyzed using descriptive statistics.

Results: The mean age was 49.8 ± 16.2 years, and 58.0% were males. Community-acquired pneumonia was the commonest diagnosis. A total of 148 antibiotics were prescribed, giving an average of 1.48 antibiotics per prescription. Empirical therapy accounted for 89.0% of cases, and monotherapy was used in 60.0%. Intravenous administration was more frequent than oral use. Amoxicillin-clavulanate, ceftriaxone, azithromycin, and piperacillin-tazobactam were the leading antibiotics prescribed. Culture testing was performed in 36.0% of patients, and overall guideline-concordant prescribing was noted in 74.0%.

Conclusion: Antibiotic use in lower respiratory tract infections was predominantly empirical, with substantial reliance on broad-spectrum agents and limited culture-guided optimization. The findings support the need for stronger antimicrobial stewardship, improved adherence to treatment recommendations, and greater emphasis on rational prescribing indicators in routine hospital practice