Antibiotic prophylaxis in a primary level hospital: a medicines use evaluation to assess compliance in caesarean sections.
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Introduction: Caesarean section births are the most important known common factor that has been linked with post-partum bacterial infections. According to the current Standard Treatment Guidelines, the prophylactic dose in surgical prophylaxis is a single dose of cefazolin, equal to the standard therapeutic dose, and given as a single stat dose prior to surgery. Multiple-dose regimes are associated with higher costs compared to a single-dose regime, not just in terms of acquisition costs but also in terms of staff time. Aim: To contribute to the rational use of antibiotics, through the application of a medicines use evaluation in a district hospital. Methods: A retrospective Medicine Use Evaluation (MUE) was carried out at Heidelberg Hospital in Gauteng. The quantitative data was collected over a 3 month study period in which the medical records of 120 female patients who delivered through Caesarean section was captured using the Medicine Use Evaluation data sheet. The qualitative phase involved structured interviews with medical officers to establish reasons for non-compliance. A total of 7 medical officers participated in the interviews. Results: None of the 120 patients received the stipulated regimen as recommended in The Standard Treatment Guidelines. Patients either received: 1 day of cefazolin, administered every 8 hours intravenously (83/120, 69.2%) or 3 days’ of cefazolin administered every 8 hours (37/120, 30.8%). Every HIV-uninfected woman (83/120, 69.2%) received 3 doses of cefazolin, whereas every HIV-infected woman received 9 doses of cefazolin and metronidazole intravenously. All patients also received 5 days’ of oral antibiotics on discharge. Eighty-five percent of patients did not have a justifiable reason for receiving a full therapeutic course. Discussion: Clear evidence was provided that the administration of antibiotic prophylaxis for Caesarean section deliveries at Heidelberg Hospital was irrational. Using MUE methods, the study identified different elements of non-compliance with the national recommendations. The study did not provide any justifications for the therapeutic use of antibiotics in patients without established or suspected infections post-operatively. Recommendations: The Standard Treatment Guidelines should provide unambiguous recommendations for the use of prophylaxis in women undergoing Caesarean sections in addition to the management of women suspected of having an established infection, and who deserve a full therapeutic course of antibiotics.