Background: Irrational antibiotic prescribing in paediatric inpatient settings remains a significant contributor to antimicrobial resistance (AMR), particularly in low- and middle-income countries where empirical treatment is common and diagnostic stewardship is limited. This study aimed to evaluate the rationality of antibiotic prescriptions among hospitalized children using WHO AWaRe classification and antimicrobial stewardship principles.

Methods: A prospective cross-sectional study was conducted between January and April 2025 at Dr. Jamal Ahmad Rashid Paediatric Teaching Hospital in Sulaimani, Iraq. A total of 600 admitted paediatric patients were assessed. Data regarding prescribing patterns, culture utilization, antibiotic classification, treatment review, and clinical outcomes were analyzed using SPSS. Prescriptions were evaluated against WHO guidelines and rational prescribing indicators.

Results: Antibiotics were prescribed to 72.5% of hospitalized children. Watch-group antibiotics accounted for 65.8% of prescriptions, with Ceftriaxone being the most frequently used agent. Culture and sensitivity testing was performed in only 8.9% of cases, and only 18% of therapies were reviewed within 48–72 hours. Notable resistance was observed among first-line antibiotics, while higher sensitivity rates were reported for Reserve antibiotics such as Linezolid and Vancomycin.

Conclusion: The findings demonstrate a high prevalence of empirical and potentially irrational antibiotic use, characterized by overreliance on broad-spectrum agents and limited microbiological guidance. Strengthening antimicrobial stewardship programs, improving adherence to AWaRe recommendations, and enhancing diagnostic capacity are urgently required to mitigate AMR and optimize paediatric healthcare outcomes in the region. 

Haidar H. Mohammed Amin, MSc, is a medical professional, public health educator, and academic lecturer specializing in antimicrobial resistance (AMR) and rational antibiotic prescribing. He holds a master of science in community health (family and community medicine) from the College of Medicine, University of Sulaimani, Iraq. His research focuses on antimicrobial stewardship, rational prescribing practices, and improving clinical outcomes in pediatric inpatient settings, particularly within low- and middle-income healthcare systems. His work aims to strengthen evidence-based prescribing and optimize healthcare delivery through structured stewardship interventions. He currently serves as a Senior Medical professional and Team Leader at MedNet Jordan – Kurdistan Branch, where he oversees medical approvals, case management, and healthcare system optimization. He has also served as a university lecturer in Community Health and as a certified medical trainer in pharmacology and public health programs across the Kurdistan Region. With extensive experience in clinical training, public health education, and healthcare leadership, he remains actively engaged in advancing antimicrobial stewardship initiatives and promoting sustainable, evidencebased healthcare practices.