Pharmacy World & Science

, Volume 32, Issue 2, pp 139–145 | Cite as

Are local clinical guidelines useful in promoting rational use of antibiotic prophylaxis in Caesarean delivery?

  • Svetlana Ristić
  • Branislava Miljković
  • Sandra VezmarEmail author
  • Dušan Stanojević
Research Article


Objectives To identify changes in prescribing patterns of antibiotic prophylaxis in Caesarean delivery after introduction of local clinical guidelines. To identify changes in outcomes of prescribing antibiotics following the implementation of local clinical guidelines on antibiotic prophylaxis. Setting University of Belgrade, Medical School, Clinic of Gynaecology and Obstetrics “Narodni front” Belgrade, Serbia. Method A quantitative retrospective analysis of antibiotic use before (January–June 2005), and following (January–June 2006) implementation of guidelines on antibiotic prophylaxis in two wards. Patients who underwent Caesarean section prior to (261) and following (281) introduction of local guidelines, participated in this study. Main outcome measures Drug utilization cost presented as the number of DDD/100 bed days/eur, the average duration of hospital stay, number of wound infections. Results There was a significant change in prescribing patterns of antibiotic prophylaxis in Caesarean section following introduction of local guidelines. The use of ceftriaxone, amikacin and metronidazole decreased (57.47% vs. 11.74%; 9.19% vs. 4.27%; 61.69% vs. 46.26%, respectively). On the other hand, the use of “older” antibiotics such as gentamicin, cefuroxime, cefazolin and ampicillin increased (14.56% vs. 29.18%; 9.2% vs. 17.44%; 9.58% vs. 45.2% and 0% vs. 3.9%, respectively). DDD/100 bed days/eur analysis revealed a 47% decrease of total cost for prophylactic antibiotic treatment in Caesarean section following local guideline implementation. In contrast, rate of wound infections and duration of hospital stay were not significantly different in both groups. Conclusion In an attempt to ensure cost-effective prophylactic use of antibiotics in Caesarean delivery, local clinical guidelines were introduced. They resulted in changes in prescribing patterns of antibiotics. There was a significant decrease in use of ‘third’ generation of cephalosporin’s whereas the use of “older” antibiotics with proven efficacy and safety increased. In contrast, there was no significant change in treatment outcomes such as wound infection and average hospital stay.


Antibiotic prophylaxis Caesarean delivery Formulary Local clinical guidelines Serbia 



We would like to thank Dr Scott Cunningham, Dr Lesly Diack, Dr Derek Stewart, Dr Dorothy McCaig and Dr Ruth Edwards from the Robert Gordon University in Aberdeen, Scottland, UK for their invaluable contribution to design and implementation of the project.


This work was a part of the Master of Science Program of the Robert Gordon University and was financially supported by the project No 145001 of the Ministry of Science, Belgrade, Republic of Serbia.

Conflicts of interest statement



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Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Svetlana Ristić
    • 1
  • Branislava Miljković
    • 2
  • Sandra Vezmar
    • 2
    Email author
  • Dušan Stanojević
    • 1
  1. 1.Clinic of Gynaecology and Obstetrics “Narodni front”, Medical SchoolUniversity of BelgradeBelgradeSerbia
  2. 2.Department of Pharmacokinetics, Faculty of PharmacyUniversity of BelgradeBelgradeSerbia

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