Objectives: To analyze the pharmacological management of respiratory tract infections in hospitalized pediatric patients. The economic burden of the disease and the adverse drug reactions occurring during the course of treatment have also been studied. Materials and Methods: It was a prospective, longitudinal, and observational study, carried out over a period of one-and-a-half years. The patients, aged one month to twelve years, diagnosed with respiratory tract infections (RTI), as confirmed by a pediatrician, were enrolled. Modified Kunin’s criteria along with the guidelines set by the Indian Academy of Pediatrics (IAP) were followed for assessing the appropriateness of the antibacterials prescribed. The adverse drug reactions occurring during the course of the treatment were noted and the economic burden of the disease was calculated as direct and indirect costs. Results: A total of 201 patients were enrolled, of whom 46% were in the age group of one month to one year. The most common diagnosis was pneumonia (76%). The number of drugs and antibacterials prescribed per patient were 4.88 ± 1.57 and 1.85 ± 0.86, respectively. Antibacterials (37.7%), intravenous fl uids (17.2%), respiratory medicines (16.6%), and analgesic/antipyretics (16.5%) were the common drug groups prescribed. Among the antibacterials, amoxicillin with clavulanic acid (47%) and cefotaxime (22%) were frequently prescribed. Appropriate antibacterial therapy was given in 42% of the cases. Salbutamol and a combination of Levosalbutamol and Ipratropium Bromide were the commonly prescribed respiratory medicines. Three adverse drug reactions (ADRs) were observed in indoor patients, all due to antibacterials. The economic burden of the disease was calculated to be Rs. 4925.14 or US$ 109.9 per patient. Conclusion: An overuse of antibacterials and respiratory medicines was seen in the study. Emphasis on proper diagnosis and treatment, education and availability of locally effective guidelines may help in a better and judicious use of drugs in children.