Hajj is an annual religious mass gathering. Antimicrobial resistance (AMR) is a global health concern. Inappropriate prescription of antimicrobials is a mediator for AMR emergence. There are reports of antimicrobial overprescribing during Hajj, increasing the risk for AMR acquisition and dissemination. We conducted a cross-sectional study assessing the appropriateness of prescribing antimicrobials for upper respiratory tract infections (URTI) in Hajj.

Pilgrims were approached after taking their medication from the pharmacy for recruitment. After consent and assessment for URTI inclusion criteria (nasal irritation, cough, sore throat, subjective headache or subjective fever); pharyngeal swabs were taken with their prescription information.

There were 185 swabbed pilgrims, 35.7% (66/185) of them received antimicrobials. The most prescribed antimicrobial was amoxicillin, 80.3% (53/66), then azithromycin, 19.7% (13/66).

There were 192 laboratory results available from the lab analysis. Bacteria were isolated from 11.5% (22/192) of the lab results, accounting for 8.6% (16/185) of swabbed pilgrims. Most common pharyngeal pathogen found was Hemophilus influenza and parainfluenza, 63.6% (14/22) and 13.6% (3/22) respectively.

After correlating the lab and prescription data, only 126 swabs’ prescription information were available. No antimicrobials were given to 47.6% (60/126) of the swabs, of which only 5.0% (3/60) had a bacterial infection. While antimicrobials were prescribed for 52.4% (66/126) of swabs, of which only 9.1% (6/66) had bacterial infections. Of the bacterial infections that were treated with antimicrobials, 66.7% (4/6) of swabs were resistant to the drug of choice given to them.

The rate of appropriate prescription of antimicrobials for URTI in Hajj is 22.2% (2/9). While the unnecessary prescription of antimicrobials for URTI in Hajj was 51.3% (60/117). The overall appropriate practice for treating URTI during Hajj is 49.2% (62/126).

There is a noticeable practical error regarding the treatment of URTIs during Hajj. Due to the crowding and short treatment time; we suggest that the health authorities devise a guideline for treating URTIs during Hajj.