OBJECTIVES: The objective of this study was to evaluate the prescription pattern of antibiotic utilization during the treatment of cough/cold and/or diarrhoea in pediatric patients.  METHODS: A cross sectional descriptive study was conducted for the period of 6 months in pediatric units of a tertiary care hospital of south India. Children under 5 years of age presenting with illness related to diarrhea and/or cough/cold were included in this study. Data were collected by reviewing patient files and then assessed in view of standard treatment guidelines. Descriptive and chi square analysis was conducted to assess the data.  RESULTS: A total of 303 patients were studied during the study period. Mean age of the patients was 3.5±0.6 years. The majority of children were admitted mainly due to chief complaint of fever (63%) followed by cough and cold (56.4%). However, the appropriateness of antibiotic prescription was high in bloody and watery diarrhea (83.3% and 82.6%; p<0.05).  Cephalosporins and penicillins were the most commonly prescribed antibiotics (46.2% and 39.9%), though    the generic prescriptions of these drugs were the lowest (13.5% and 10%).  The seniority of prescriber was significantly associated with the appropriateness of prescriptions (P<0.05). Antibiotics prescription was higher (93.5%) in Cold/cough and diarrhea in comparison to Cough/cold (85) or diarrhea (75%) alone. CONCLUSIONS: The study observed high rate of antibiotic prescription. Their appropriateness with the standard guidelines was also below par.  Not many drugs given in National List of Essential Medicine (NLEM) were prescribed in this study, moreover, the generic prescription of these drugs were also poor. Appropriate measures need to be taken to seal the knowledge gaps to enhance appropriateness of antibiotics.