1Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
2Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
3Department of General Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Background and Objectives: Antimicrobial prophylaxis has proven effective in controlling postoperative infection in almost all types of surgery. The American Society of Health-System Pharmacists (ASHP) guideline summarizes current knowledge on the appropriate use of antimicrobials for surgical prophylaxis. However, there is limited information on the extent to which the surgical prophylaxis procedures in Iran follow the standard recommendations. Hence, this study was conducted to make the situation clearer by auditing the use of prophylactic antimicrobials in a referral tertiary care center based on of ASHP guideline. Methods: This cross-sectional study was carried out from April to September 2015 in the surgical wards of a 850-bed hospital (Alzahra Hospital, Isfahan, Central Iran). All patients aged ≥ 18 years admitted for elective surgery during the study period were recruited. Data on antibiotic indication and choice, dose, dosing interval, route of administration, timing of first administration, and duration of prophylaxis were collected prospectively from medical records and compared with ASHP guideline. Findings: Only 22% of procedures fully complied with the guideline recommendations, and in all but half of the criteria the level of compliance was below 50%. The lowest level of compliance was found in duration of prophylaxis (14%), followed by appropriate agent choice (35%), and timing of the initial dose (42%). Conclusions: Our study revealed that the majority of antibiotic prescriptions in surgical prophylaxis do not follow the standard treatment guideline. The situation calls for development of national/local standards and encouraging hospitals to adopt institutionalizing interventions to alleviate the health risks associated with inappropriate prophylactic antimicrobial treatment.