Background <p>Pre-hospital antibiotic exposure, including both empiric prescriptions and self-administration, is of increasing concern in pediatric care. Such practices can contribute to the development of antibiotic resistance and carry significant risks to children’s health, especially in resource-limited settings. This study aimed to measure the prevalence of pre-hospital antibiotic exposure among children at a tertiary care center in India and identify the factors associated with this exposure.</p> Methods <p>This cross-sectional study was conducted over six months, from January to June 2024, at a tertiary care center in Northern India. Caregivers of 774 children aged 1 month to 18 years were interviewed using a structured questionnaire to collect data on antibiotic use prior to hospital visits. Statistical analysis was carried out using SPSS, with categorical variables depicted as frequencies and percentages. Bivariate analysis was done to appraise the factors associated with pre-hospital antibiotic exposure.</p> Results <p>From the 774 children, 20.67% (160/774) were exposed to antibiotics prior to hospital admission. Empiric prescriptions accounted for 82.50% (132/160) of these cases, while self-administration contributed to 17.50% (28/160). The most commonly used antibiotics were amoxicillin-clavulanic acid (14.38%), cefixime (13.75%), and azithromycin (11.86%). Factors such as caregivers’ education, profession, and symptoms like fever and loss of appetite were substantially associated with pre-hospital antibiotic use. Children under 6 years old and those from lower-income families had lower rates of antibiotic exposure.</p> Conclusion <p>The prevalent use of antibiotics before hospital consultations is a serious concern. There is an urgent need to strengthen antibiotic stewardship, improve access to healthcare services, and better public education to decrease the inappropriate use of antibiotics and mitigate the growing risk of antibiotic resistance.</p> Graphical Abstract <p></p>