Background: Respiratory Tract Infection (RTI) is the global cause of death in children. Nepal, India, Indonesia and Bangladesh account 40% of the global cause. Antimicrobials are the most commonly prescribed drugs in hospitals whose appropriateness solely relies on its rational use. Methods: A cross-sectional study was carried out in pediatric in-patients suffering from the respiratory infection at a tertiary care teaching hospital. WHO/INRUD prescribing indicators and appropriateness index were used in determination of the drug prescribing indicators and appropriateness of antimicrobials. Results: A total of 108 samples male incidence were higher than female. The maximum samples were found in between the age group 1-5 years. Brahaman and Chhetri were the found in larger frequency. Bronchopneumonia 67 and Acute Bronchiolitis 21 (19.4%) were the most common diagnosis. Cefotaxime was the drug found to be used in maximum number 81 (54.4%) following Gentamicin and Amoxy-Clav. In 58 (53.7%) sample Cephalosporin were used as single drug, following its combination with aminoglycosides 20 (18.6%) Out of which cefotaxime and gentamicin combination was found to be in 15 samples. In discharged medication 70.3% of the samples were prescribed with Cephalosporin. The average no of drug per prescription were found to be 4.31. 7.7% of the drugs were found to be prescribed in generic name. The antibiotic encounter per samples and medication from essential drug list were found to be 100%. Conclusion: Total of 140 antibiotics were assessed for appropriateness where 50 (35.71%) of antibiotics were found to be appropriate and 90 (64.29%) were found to be inappropriate. The average Medication Inappropriateness (MAI) was 3.29. The mean MAI per prescription was found to be 1.69 ± 0.47. 33 (31.43%) of the samples were found to be appropriate and 72 (68.57%) sample were found to be inappropriate.