<![CDATA[Antibiotics are the mainstay of pneumonia therapy, and irrational use accelerates antimicrobial resistance. This structured narrative review analyzes the pattern and rationality of antibiotic use in hospitalized pneumonia patients in Indonesia, based on ten original studies published between 2022 and 2026 covering data from 2019 to 2024. The studies applied quantitative Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) and Drug Utilization 90% (DU90%) methods, plus the qualitative Gyssens method and rightness-of-use criteria. Third-generation cephalosporins (mainly ceftriaxone) and fluoroquinolones (mainly levofloxacin) dominated prescribing in almost all hospitals. Total DDD/100 patient-days varied widely, from 73.64 to 233.7, reflecting doses exceeding the WHO DDD standard, therapy duration, and drug availability. DU90% segments comprised two to seven agents and were consistently dominated by broad-spectrum antibiotics. Qualitative assessment was reported in only three of the ten studies: Gyssens category 0 prescriptions ranged from 62.36% to 80.41%, whereas compliance with rightness-of-use criteria reached 92.16–100%. No study reported culture and susceptibility data. Antibiotic selection converges with national guidelines, but the dominance of broad-spectrum agents, doses and durations exceeding standards, and limited qualitative evaluation underscore the need to strengthen hospital antimicrobial resistance control programs.]]>
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