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
This is a preview of subscription content, log in to check access.
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
Miesnik SR, Reale BJ. A review of issues surrounding medically elective cesarean delivery. J Obstet Gynecol Neonatal Nurs. 2007;36:605–15.PubMedGoogle Scholar
Thomas J, Paranjothy S. National sentinel Caesarean section audit report. London: Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit, 2001. ISBN 1-900364-66-2.Google Scholar
Sparić R, Dokić M, Argirović R, Kadija S, Bogdanović Z, Milenković V. Incidence of postpartum post-cesarean hysterectomy at the Institute of Gynecology and Obsterics, Clinical Center of Serbia, Belgrade. Srp Arh Celok Lek. 2007;135:160–2.CrossRefPubMedGoogle Scholar
Chamberlain G, Steer P. ABC of labour care. Operative delivery. BMJ. 1999;318:1260–4.PubMedGoogle Scholar
Henderson EJ, Love EJ. Incidence of hospital-acquired infections associated with Caesarean section. J Hosp Infect. 1995;29:245–55.CrossRefPubMedGoogle Scholar
Rudge MV, Atallah AN, Peraçoli JC, Tristão Ada R, Mendonça Neto M. Randomized controlled trial on prevention of postcesarean infection using penicillin and cephalothin in Brazil. Acta Obstet Gynecol Scand. 2006;85:945–8.CrossRefPubMedGoogle Scholar
Chelmow D, Ruehli MS, Huang E. Prophylactic use of antibiotics for nonlaboring patients undergoing cesarean delivery with intact membranes: a meta-analysis. Am J Obstet Gynecol. 2001;184:656–61.CrossRefPubMedGoogle Scholar
Häger RM, Daltveit AK, Hofoss D, Nilsen ST, Kolaas T, Øian P, et al. Complications of Caesarean deliveries: rates and risk factors. Am J Obstet Gynecol. 2004;190:428–34.CrossRefPubMedGoogle Scholar
Smaill F, Hofmeyer GJ. Antibiotic prophylaxis for Caesarean section. The Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD000933. doi:10.1002/14651858.CD000933.
Weinberg M, Fuentes JM, Ruiz AI, Lozano FW, Angel E, Gaitan H, et al. Reducing infections among women undergoing Caesarean section in Colombia by means of continuous quality improvement methods. Arch Intern Med. 2001;161:2357–65.CrossRefPubMedGoogle Scholar
Belongia EA, Schwartz B. Strategies for promoting judicious use of antibiotics by doctors and patients. BMJ. 1998;317:668–71.PubMedGoogle Scholar
Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993;342:1317–22.CrossRefPubMedGoogle Scholar
Penney G, Foy R. Do clinical guidelines enhance safe practice in obstetrics and gynaecology? Best Pract Res Clin Obstet Gynaecol. 2007;1:657–73.CrossRefGoogle Scholar
The selection of essential drugs. Report of a WHO Expert Committee Geneva, World Health organisation, 2003 (WHO Technical Report Series, No.920). ISBN 92 4 120920 8.Google Scholar
Mach R, Vlcek J, Prusova M, Batka P, Rysavy V, Kubena A. Impact of a multidisciplinary approach on antibiotic consumption, cost and microbial resistance in a Czech hospital. Pharm World Sci. 2007;29:565–72.CrossRefPubMedGoogle Scholar
Shekelle PG, Woolf SH, Eccles M, Grimshaw J. Clinical guidelines: developing guidelines. BMJ. 1999;318:593–6.PubMedGoogle Scholar
Grol R, Dalhuijsen J, Thomas S, Veld C, Rutten G, Mokkink H. Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. BMJ. 1998;317:858–61.PubMedGoogle Scholar
Kankuri E, Kurki T, Carlson P, Hiilesmaa V. Incidence, treatment and outcome of peripartum sepsis. Acta Obstet Gynecol Scand. 2003;82:730–5.PubMedGoogle Scholar
Faro S, Martens MG, Hammill HA, Riddle G, Tortolero G. Antibiotic prophylaxis: is there a difference? Am J Obstet Gynecol. 1990;162:900–7.PubMedGoogle Scholar
Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000;(2):CD001136.Google Scholar
de With K, Bestehorn H, Steib-Bauert M, Kern WV. Comparison of defined versus recommended versus prescribed daily doses for measuring hospital antibiotic consumption. Infection. 2009;37:349–52.CrossRefPubMedGoogle Scholar
Kuster SP, Ruef C, Ledergerber B, Hintermann A, Deplazes C, Neuber L, et al. Quantitative antibiotic use in hospitals: comparison of measurements, literature review, and recommendations for a standard of reporting. Infection. 2008;36:549–59.CrossRefPubMedGoogle Scholar
Muthukumarappan K, Rigby C, Johanson R, Jones P. Improving the standards of care for women having Caesarean sections. J Obstet Gynaecol. 2000;20:584–8.CrossRefPubMedGoogle Scholar
Taylor GM. An audit of the implementation of guidelines to reduce wound infection following Caesarean section. Health Bull (Edinb). 2000;58:38–44.Google Scholar
Ding H, Yang Y, Wei J, Fan S, Yu S, Yao K, et al. Influencing the use of antibiotics in a Chinese pediatric intensive care unit. Pharm World Sci. 2008;30:787–93.CrossRefPubMedGoogle Scholar
Zhang W, Shen X, Wang Y, Chen Y, Huang M, Zeng Q, et al. Antibiotic use in five children’s hospitals during 2002–2006: the impact of antibiotic guidelines issued by the Chinese Ministry of Health. Pharmacoepidemiol Drug Saf. 2008;17:306–11.CrossRefPubMedGoogle Scholar
Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318:527–30.PubMedGoogle Scholar
Shapiro DW, Lasker RD, Bindman AB, Lee PR. Containing costs while improving quality of care: the role of profiling and practice guidelines. Annu Rev Public Health. 1993;14:219–41.CrossRefPubMedGoogle Scholar
Lomas J. Making clinical policy explicit. Legislative policy making and lessons for developing practice guidelines. Int J Technol Assess Health Care. 1993;9:11–25.CrossRefPubMedGoogle Scholar