Antibiotic prescribing in women during and after delivery in a non-teaching, tertiary care hospital in Ujjain, India: a prospective cross-sectional study

Abstract

ObjectivesAntibacterial drugs (hereafter referred to as antibiotics) are crucial to treat infections during delivery and postpartum period to reduce maternal mortality. Institutional deliveries have the potential to save lives of many women but extensive use of antibiotics, add to the development and spread of antibiotic resistance. The aim of this study was to present antibiotic prescribing among inpatients during and after delivery in a non-teaching, tertiary care hospital in the city of Ujjain, Madhya Pradesh, India.MethodsA prospective cross-sectional study was conducted including women having had either a vaginal delivery or a cesarean section in the hospital. Trained nursing staff collected the data on daily bases, using a specific form attached to each patient file. Statistical analysis, including bivariate and multivariable logistic regression was conducted.ResultsOf the total 1077 women, 566 (53%) had a vaginal delivery and 511 (47%) had a cesarean section. Eighty-seven percent of the women that had a vaginal delivery and 98% of the women having a cesarean section were prescribed antibiotics. The mean number of days on antibiotics in hospital for the women with a vaginal delivery was 3.1 (±1.7) and for the women with cesarean section was 6.0 (±2.5). Twenty-eight percent of both the women with vaginal deliveries and the women with cesarean sections were prescribed antibiotics at discharge. The most commonly prescribed antibiotic group in the hospital for both the women that had a vaginal delivery and the women that had a cesarean section were third-generation cephalosporins (J01DD). The total number of defined daily doses (DDD) per100 bed days for women that had a vaginal delivery was 101, and 127 for women that had a cesarean section.ConclusionsThe high percentage of women having had a vaginal delivery that received antibiotics and the deviation from recommendation for cesarean section in the hospital is a cause of concern. Improved maternal health and rational use of antibiotics are intertwined. Specific policy and guidelines on how to prescribe antibiotics during delivery at health care facilities are needed. Additionally, monitoring system of antibiotic prescribing and resistance needs to be developed and implemented.

Prescribing pattern of antibiotics among postoperative patients admitted in gynaecology and obstetrics department of tertiary care hospital in Northern India

“…Use of antibiotic prophylaxis is widely recommended after caesarean section because there is a clear systematic review that it reduces incidence of 11 Third generation cephalosporin were also observed to be commonly used in other studies also. 10,12 This group of drugs are highly potent and have wide spectrum, active against both gram positive and gram negative organisms and in present study maximum of the antibiotics after surgical intervention was cephalosporin.…”

“…In our study, maximum number of patients were in age group of less than 30 years and were admitted as full term pregnancy with normal delivery and these patients were prescribed with oral antibiotic cefuroxime (17.3%) and amoxycillin clavulanate (6.59%) for 7 to 10 days and it is in concurrence with other studies. 10 The antibiotic prescribed after caesarean section in our study was ceftriaxone in combination with tinidazole and gentamycin. Use of antibiotic prophylaxis is widely recommended after caesarean section because there is a clear systematic review that it reduces incidence of 11 Third generation cephalosporin were also observed to be commonly used in other studies also.…”

Protocol: a ‘One health’ two year follow-up, mixed methods study on antibiotic resistance, focusing children under 5 and their environment in rural India

“…We have earlier reported high proportion of antibiotic use for common infections among outpatients [ 24 ] and among admitted patients with a suspected focus of infections [ 25 , 26 ]. High rate of antibiotic prescribing has been noted in surgical ward [ 25 , 27 ], in peri-partum period [ 28 ] and in patients admitted in medical intensive care unit [ 29 ]. Inappropriate choice of antibiotics and also inappropriately long duration of antibiotic therapy for post-surgery prophylaxis has been documented [ 25 ].…”

Antibiotic prescribing among inpatients with infectious and non-infectious indications in obstetrics and gynaecology departments at two tertiary care hospitals in Central India

“…Antibiotic prescription to this group of patients cannot be justified as even the prophylactic use of antibiotics for FTND is not recommended (39). A previous study from Ujjain district in India has shown an antibiotic prescribing to 87% FTND patients (40).An episiotomy is a possible indication for antibiotic prophylaxis in FTND; however, according to a Cochrane review, further studies are required to ascertain the need for antibiotic prophylaxis for an episiotomy (41). Thus, a targeted study is suggested to investigate the rationality of prescribing antibiotics for FTND.…”