Acute respiratory infections (ARI) are one of the top 10 killer diseases in children. In developing countries, the treatment is often initiated by self-medication (SM) before going to the hospital in case of a complication. This study assessed the level of self-medication and the adequacy of hospital prescribing patterns of antibiotics for the management of acute respiratory infections in children under five. It was a cross-sectional survey conducted in 2018, including a face-to-face interview with 227 children’s mothers for self-medication and a review of 1162 medical files available at the pediatrics wards of Panzi General Hospital and University Clinic in Bukavu. Of 227 mothers interviewed, 168(74%) self-medicated children with six antibiotics, mainly amoxicillin (67%), and Cotrimoxazole (60%), principally to avoid medical consultation fees and to mitigate the early signs of the disease. However, among them, 49.8% rushed to the hospital after a complication. Of the 1162 medical files reviewed, 248(21.34%) are ARI cases of which 53% males and 47% females. Under 2 years constitute 85%. Dominant ARIs were acute pharyngitis (19.1%), acute otitis media (15.3%), bronchial superinfection (23.3%), and pneumonia (16.3%). The mortality rate attributable to ARIs was 17.5% (14/80). The antibiotics used in hospital include gentamicin (67%) in combination with cefotaxime, ampicillin, and azithromycin. The unprofessional dispensing of antibiotics in community pharmacies encouraged the high level of self-medication.