Abstract
Introduction:
Acute respiratory tract infections (ARTIs) are common causes of outpatient visits and frequent targets of antibiotic prescriptions, despite their predominantly viral etiology. The SARS-CoV-2 pandemic significantly influenced prescribing practices, raising concerns over inappropriate antibiotic use and antimicrobial resistance. This study evaluated antibiotic prescribing trends among adult ARTI patients during the pandemic in a tertiary care hospital in Eastern India.

Methods:
A cross-sectional observational study was conducted from January 2020 to December 2022 at Calcutta National Medical College, Kolkata. Data from 148 adult patients were collected using a structured case report form. Patient demographics, comorbidities, clinical presentation, and antibiotic prescriptions were analyzed using descriptive statistics and Chi-square tests to assess associations. A p-value <0.05 was considered statistically significant.

Results:
Antibiotics were prescribed in 59.5% of cases, with doxycycline (27.6%) and amoxicillin-clavulanic acid (25.0%) being most common. Monotherapy (72.7%) and short-duration therapy (4–7 days in 62.5%) were predominant. A statistically significant association was found between comorbidities and antibiotic prescription (χ² = 11.56, p = 0.0007), while no significant link was observed with age groups. Patients with hypertension and diabetes were more likely to receive broad-spectrum antibiotics.

Conclusion:
The high rate of empirical antibiotic use, despite the viral nature of ARTIs, reflects the impact of diagnostic uncertainty and perceived patient risk during the COVID-19 pandemic. These findings highlight the urgent need for strengthened antimicrobial stewardship, clinician education, and integration of rapid diagnostics, especially in future public health emergencies.

Key words: Antibiotic prescription, ARTI, SARS-CoV-2, Antimicrobial resistance, Doxycycline, Eastern India