Antibiotic misuse especially in managing ARI is one of the main reasons for the widespread of antibiotic resistance. This problem is best addressed by antibiotic stewardship programmes which focus on the right use of antibiotics to enhance patient outcomes and sustain the effectiveness of the drugs. This research was therefore carried out with the primary objective of assessing the effectiveness of an ASP on rational dispensing patterns and patient outcomes among ARI patients within the Lady Reading Hospital in Peshawar Pakistan. Hence, a retrospective observational study approach was used with data from 550 patients diagnosed with ARI attending Lady Reading Hospital from January to December, 2022. Evaluation of the stewardship program included measuring the changes in the prescription of antibiotics and the patients’ clinical outcome after and before the program. These descriptive results were analyzed using chi square and multivariate logistic regression analysis depending on the study variables. The above findings indicate that after the initiation of the antibiotic stewardship program for the patient population the use of broad-spectrum antibiotics decreased from 78.4% to 47.1% while the use of narrow-spectrum antibiotics increased from 21.6% to 52.9%. Further on, the positive incremental changes were made to patient satisfaction from where the mean length of hospital stay was reduced from 8.4 days to 6.2 days; the number of patients who had complications reduced by 38.8% from 14.9% to 9.1%; and finally, the readmission rate per patient was reduced from 11.3% to 6.7%. The findings of the study therefore confirmed that the LSM AHL antibiotic stewardship program had enhanced prescription practices, and patients’ experiences in the management of ARIs. As such, these results provide the evidence of the need for the constant enforcement and practice of stewardship programs in the healthcare facility to reduce and prevent antibiotic resistance among patients.