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Background and Importance Hospital-acquired pneumonia (HAP) is a frequent infection associated with increased morbidity, mortality, and healthcare costs. Empirical antibiotic treatment should be guided by local protocols considering risk factors for resistant pathogens. Assessing the adequacy of empirical treatment protocols is essential to optimise antimicrobial stewardship and clinical outcomes.Aim and Objectives To evaluate the adherence to empirical treatment protocols for HAP in a tertiary care hospital.Material and Methods A retrospective observational study was conducted including adult patients prescribed one of the available HAP empirical treatment protocols through the computerised physician order entry system between October 2022 and September 2025. Demographic (sex, age) and clinical variables (hospital stay after prescription, discharge or death) were collected, along with parameters related to protocol adequacy: β-lactam allergy, severity (sepsis or septic shock), and risk factors (RF) for Pseudomonas aeruginosa (previous culture within 1 year, hospitalisation with antibiotics in the last 3 months, immunosuppression, chronic lung disease) and methicillin-resistant Staphylococcus aureus (MRSA) (haemodialysis, prior colonisation/infection, MRSA prevalence area >20%). Adequacy was defined according to diagnosis, allergy, severity, length of stay, and RF for P. aeruginosa and/or MRSA. Categorical variables were expressed as frequencies (%) and quantitative ones as mean ± SD or median (IQR). Comparisons were made using Chi-squared or Mann–Whitney U tests. Statistical analysis was performed with Stata v15.1.Results A total of 52 protocols were prescribed to 50 patients (64.0% men; median age 76 (IQR 63–86) years). Only 9 (17.3%) prescriptions were adequate. Main causes of non-adherence (82.7%) were incorrect diagnosis (69.8%), severity mismatch (18.6%), and inadequate consideration of risk factors for P. aeruginosa (7.0%) or MRSA (2.3%). No significant differences were observed between adequate and non-adequate prescriptions in mortality (12.5% vs 16.3%; p=0.696) or length of stay (7 vs 9 days; p=0.537). The departments with the highest prescription rates were Emergency (51.9%), Internal Medicine (25.0%), and Pulmonology (5.8%).Conclusion and Relevance Adherence to HAP empirical treatment protocols was low, mainly due to diagnostic inaccuracy. No significant differences in mortality or hospital stay were observed between adequate and non-adequate prescriptions. Incorporating treatment protocols for other infectious syndromes into the prescribing system and conducting educational interventions may improve adherence and antimicrobial use.Conflict of Interest No conflict of interest