Journal of Research in Pharmacy Practice

Adherence to American society of health‑system pharmacists surgical antibiotic prophylaxis guidelines in a teaching hospital

Document Type : Original Article

Authors

. Mohammadreza Rafati 1
. Afshin Shiva 1
. Amirhosein Ahmadi 2
. Omran Habibi 2

1 Department of Clinical Pharmacy, Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran

2 Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran

Abstract
Objective: Surgical site infections are the second most common type of adverse events 
occurring in hospitalized patients, whereas an estimated 40-60% of these infections are thought 
to be preventable. Choice of regimen, administration timing or duration of antibiotic prophylaxis 
is reported to be inappropriate in approximately 25-50% of cases. We tried to evaluate an 
antibiotic administration pattern for surgical antibiotic prophylaxis in a teaching hospital.
Methods: This study was conducted at the general surgery and orthopedic wards 
of a teaching hospital affiliated with Mazandaran University of Medical Sciences. The 
medical records of admitted patients who underwent different surgical procedures were 
reviewed. Compliance was assessed with the recommendations of the American Society 
of Health‑System Pharmacists’ guidelines for every aspect of antibiotic prophylaxis. All data 
were coded and analyzed by SPSS16 software using Student’s t‑test and Chi‑square test.
Findings: During 1 year, 759 patients who underwent different surgeries were included in 
the study. Mean age of patients was 32.02 ± 18.79 years. Hand and foot fractures repair were 
the most frequent surgery types. About 56.4% of administered prophylactic antibiotics were 
in accordance with the American Society of Health System Pharmacists (ASHP) guidelines 
regarding prophylaxis indication. The most commonly antibiotic used was cefazolin and 
antibiotic choices were appropriate in 104 of 168 surgical procedures (62%). Gentamicin, 
metronidazole and ceftriaxone were the most frequently antibiotics that used inappropriately. 
Only in 100 of 168 procedures, duration was concordant with the ASHP guideline, whereas 
in 68 procedures, duration was longer than recommended time. In 98 procedures, the dose 
was lower and in one procedure, it was higher than recommended doses.
Conclusion: Although such guidelines have been in place for many years, studies showed 
that much inappropriate antibiotic use as prophylaxis and poor adherence to guidelines 
are still major issues. It is essential for surgeons to be aware to consider the best antibiotic 
choices, dose and duration based on reliable guidelines for antibiotic prophylaxis.

Keywords

Adherence
antibiotic prophylaxis
American Society of Health System  Pharmacists guidelines
surgical
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Journal of Research in Pharmacy Practice
Volume 3, Issue 2
Spring 2014
Pages 62-66

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