OBJECTIVES: Inappropriate use of broad-spectrum antibiotics is accompanied with additional cost and leads to the emergence of resistant bacteria. This study aimed to identify factors associated with prescribing broad-spectrum antibiotics for children with upper respiratory tract infections (URI) in outpatient settings. METHODS: A cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey-Outpatient Departments (NHAMCS-OPD) between 2006 and 2010 was conducted. Descriptive statistics of visits for patients younger than 18 years were estimated. Logistic regressions were used to identify socio-demographic and clinical characteristics associated with prescribing broad-spectrum antibiotic. A stratified analysis by age (≤2 vs >2) was conducted. All analyses were performed using the Statistical Analysis Software (SAS) version 9.3 at an alpha value of 0.05. RESULTS: A total of 4,013 outpatient visits for children with URI were included. Of them, 46% were visits from persons 2 years or younger. Majority of the visits were from persons who were White (85.6%), had private insurance (63.6%), were seen by pediatricians (63.8%), and were diagnosed with acute otitis media (71.5%). Broad-spectrum antibiotics were prescribed in about 40% of the visits, accounting for 6.8 million visits annually. Bivariable analysis showed that age, region, physician specialty, insurance type, and URI-specific diagnosis were associated with broad-spectrum prescribing (p<0.05). Multivariable analysis showed that visits in south region compared to the west region [OR=2.376 (1.377 – 4.101)] and acute pharyngitis compared to acute otitis media [OR= 0.525 (0.365 – 0.754)] were associated with broad-spectrum prescribing. Among those older than 2 years, females [OR=0.604 (0.392 – 0.929)] and Black compared to White [OR=0.376 (0.152 – 0.932)] were also associated with broad-spectrum prescribing. CONCLUSIONS: Prescribing of broad-spectrum antibiotics is common for children with URI in outpatient settings. Efforts to decrease broad-spectrum antibiotics use should be focused more toward certain conditions, geographic regions, and age groups.