Assessment of rational use of antibiotics in surgical prophylaxis and post- operative cases at district hospital Gulbarga

Abstract

Background: Postoperative wound infections are the major cause of morbidity in surgical patients. The use of pre and peri-operative antibiotics, with sound and appropriate principles of prophylaxis are applied can result in a reduced risk of postoperative infection. Although the principles of antimicrobial prophylaxis for surgical procedures have been well defined for many years, inappropriate and excessive use of antimicrobials for this purpose remains widespread.Methods: This was a prospective study conducted on the inpatients undergoing surgical procedures. ASHP (American Society of Health System Pharmacists) and SIGN (Scottish Intercollegiate Guidelines Network) guidelines were used as the standard guideline.Results: Of the total 150 procedures reviewed, 130 procedures were entered in the analysis. Of these procedures, the rate of totally compliant prescriptions was 28.46%. Totally in 93 (71.53%) patients, the antibiotic prophylaxis was found to be inappropriate. In 36 (27.70%) patients, indication for antibiotic prophylaxis was not proper and in total 38 (44.19%) patients, where antibiotic prophylaxis was justified and given, proper antimicrobial agent was not used.Conclusions: Instead of existence of the written guidelines for antimicrobial surgical prophylaxis there are significant deviations from the recommendations in current clinical practice. Adherence of antibiotic prophylaxis to these guidelines is needed to be evaluated routinely in clinical practice.

A study on prescribing pattern of cephalosporins utilization and its compliance towards the hospital antibiotic policy in surgery ward of a tertiary care teaching hospital in India

“…19 Surgical prophylaxis (SP) with the 3GCs is not recommended for most procedures (clean and clean-contaminated) because it leads to the unacceptable increase in the treatment cost as well as the emergence of resistance. 15,19 First and second generations (cefazolin, cefuroxime) are widely indicated for most of the surgical prophylaxis. 19 In the current study however, more than half of patients were administered by ceftriaxone with unnecessarily prolonged use of more than 24 hrs, against the recommendations of the policy.…”

“…According to the National Academy of Sciences and the National Research Council, surgical wounds are classified as clean, clean-contaminated and contaminated to pre-emptively identify the SSI risk in patients. 14,15 Clean wounds are uninfected operative wound which are primarily closed with no acute inflammation and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered; no technique break (for example, elective inguinal herniorrhaphy). Clean-contaminated wounds arise from intentional, controlled entry in a hollow viscus (respiratory, alimentary, genital, or urinary tract) without subsequent contamination.…”

Assessment of Antibiotic Utilization Pattern In Hospital Settings

“…The prescription pattern can indicate the medical practitioner's comprehension of the disease conditions and patient medical history. Prescribing can be improved by tailoring the hospital antimicrobial formulary and by adhering to available regional guidelines considering the antibiogram of the hospital setting and thereby promoting the well judged use of antimicrobials which will aid in controlling the rise of antimicrobial resistance (Kamath et al, 2014;Ather et al, 2017). Most of the antibiotic(s) are prescribed by brand name rather than generic name.…”

Compliance of antibiotic prescriptions to the antibiotic policy in surgical cases at an Indian tertiary care hospital

“…It is a well-known fact that high morbidity and mortality in humans were major concern during pre-antibiotic era. (1,2) With tremendous research and invention in the area of pharmaceuticals the use of antibiotics in all kinds of medical treatments have increased manifold. The use of antibiotic however in many cases are not justifiable as it has resulted into antimicrobial resistance (AMR) (3) .…”

“…There are studies that have evidence of, administration of prophylactic antibiotics in certain surgical procedures have led to decrease post-operative infections, decrease the length of hospital stay and reduce the overall cost of care. (2) It is evident from many studies that with use of sound and appropriate principles of prophylaxis applied during pre and peri-operative instances results in reduced risk of post-operative infection. (3) There are also cases where, prophylactic or post-operative antibiotics are not required.…”