Rational Antibiotic Prescribing in Paediatric Respiratory Tract Infections: A Modified Kunin’s Criteria Assessment at A South Indian Tertiary Care Hospital

Abstract

Respiratory tract infections (RTIs) remain one of the leading causes of paediatric morbidity in South India and are frequently associated with inappropriate antibiotic use, thereby increasing the risk of antimicrobial resistance. Objective: To evaluate the rationality of antibiotic prescriptions among paediatric inpatients diagnosed with RTIs using the Modified Kunin’s Criteria in a tertiary care hospital in South India. Methodology: This was a prospective cross-sectional study conducted over six months, involving 150 paediatric inpatients aged under 12 years diagnosed with RTIs. Prescription patterns were assessed using the Modified Kunin’s Criteria. Data regarding demographic characteristics, clinical diagnosis, and use of antimicrobials were analysed. Descriptive statistics were used, and proportions were reported with 95% confidence intervals (CIs). Results: Children aged 9–12 years constituted the majority of the study population with male predominance. Pneumonia was the most frequently diagnosed RTI, followed by tonsillitis and bronchiolitis. Antibiotics were prescribed to 76.7% of patients, with Ceftriaxone–Sulbactam and Amoxicillin–Clavulanate being the most commonly used agents. Antiviral drugs accounted for 23.33% of prescriptions. Based on Modified Kunin’s Criteria, 75.4% of prescriptions were appropriate, while 24.7% were inappropriate. The major causes of inappropriate use included empirical therapy without culture confirmation and selection of suboptimal antibiotics. Conclusion: Although most prescriptions adhered to rational antimicrobial use, nearly one-fourth were inappropriate. These findings highlight the need for continuous prescription audits, strict adherence to antimicrobial stewardship principles, and increased utilization of culture-sensitivity testing to improve antibiotic prescribing practices in paediatric RTIs.