Effects of an Educational Module in Rationalizing Surgical Prophylaxis

Nagdeo, Neena; Sonarkar, Rajiv; Thombare, Vilas R; Akhtar, Murtaza; Dasgupta, Sayandev

doi:10.1007/s12262-015-1297-5

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…In our study, a third-generation cephalosporin was the preferred antibiotic choice in both settings. Similar results were shown in two studies conducted at general surgery department in Western India (26) and at a private tertiary healthcare hospital in Southern India (27), where third-generation cephalosporins were reported as the most commonly prescribed class of antibiotics. The preference to a broader spectrum antibiotic, such as the third-generation cephalosporin, might be due to the overall increase in prevalence of bacterial resistance to antibiotics in India that has been observed in other settings (4).De-escalation of antibiotic therapy is suggested for settings where broad-spectrum antibiotics are the first drug of choice, but was not found at our settings (28).…”

Section: Discussionsupporting

confidence: 88%

Diagnose-Specific Antibiotic Prescribing Patterns at the Otorhinolaryngology Inpatient Departments of Two Private Healthcare Facilities in Central India: A Five Year Observational Study

Silfwerbrand

Verma

Sjökvist

et al. 2019

Preprint

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Background Antibiotics are overprescribed in low-and-middle-income countries where the infection rate is high. The global paucity of standard treatment guidelines and reliable prescription data is a barrier to rationalise antibiotic use and combat antibiotic resistance. Moreover, there is a lack of diagnose-specific prescription data from high infection risk departments such as the otorhinolaryngology (ENT). The purpose of the study was to present diagnose-specific antibiotic prescribing patterns at ENT inpatient departments of a teaching hospital and a non-teaching hospital from Indian private healthcare sector. Methods Data of all consecutive inpatients at the department (n=3527) were collected for five years (2008-2013). Analyses were conducted for inpatients aged >15 years (n=2909) using the World Health Organization’s methodologies. Patient records were divided into four diagnoses (indication) groups, i.e., surgical, non-surgical, chronic suppurative otitis media (CSOM) and others. Results Of 2909 inpatients, 51% had surgical diagnoses. An average of 83% inpatients in the clean surgery group, 78% in viral infection and 75% in non-infectious groups were prescribed antibiotics. CSOM was the most common diagnosis at both settings (883/2909 inpatients), where nearly 90% inpatients were prescribed antibiotics. Overall, third-generation cephalosporins and fluoroquinolones were most commonly prescribed. Conclusions This study highlights prescribing antibiotic to the unindicated diagnosis groups, i.e., clean surgeries, viral infections, and non-infectious diagnoses. Recommended single-prophylactic dose of antibiotic was not prescribed for the majority of clean-contaminated surgeries. Prolonged empirical prescribing and insignificant use of the microbiology laboratory was evident in both settings. A meticulous analysis of clean surgery group highlighted the universal applicability issue of available global guidelines.

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Section: Discussionsupporting

confidence: 88%

Diagnose-Specific Antibiotic Prescribing Patterns at the Otorhinolaryngology Inpatient Departments of Two Private Healthcare Facilities in Central India: A Five Year Observational Study

Silfwerbrand

Verma

Sjökvist

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…In our study, a third-generation cephalosporin was the preferred antibiotic choice in both settings. Similar results were shown in two studies conducted at a general surgery department in Western India [26] and at a private tertiary healthcare hospital in Southern India [27], where third-generation cephalosporins were reported as the most commonly prescribed class of antibiotics. The preference for a broader spectrum antibiotic, such as the third-generation cephalosporin, might be due to the overall increase in the prevalence of bacterial resistance to antibiotics in India that has been observed in other settings [4].…”

Section: Discussionsupporting

confidence: 88%

Diagnose-Specific Antibiotic Prescribing Patterns at Otorhinolaryngology Inpatient Departments of Two Private Sector Healthcare Facilities in Central India: A Five-Year Observational Study

Silfwerbrand

Verma

Sjökvist

et al. 2019

IJERPH

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Antibiotics are over-prescribed in low-and-middle-income countries, where the infection rate is high. The global paucity of standard treatment guidelines and reliable diagnose-specific prescription data from high-infection risk departments such as the otorhinolaryngology (ENT: ears, nose and throat) is a barrier to rationalize antibiotic use and combat antibiotic resistance. The study was conducted to present diagnose-specific antibiotic prescribing patterns of five years at ENT inpatient departments of two private-sector Indian hospitals. Data of all consecutive inpatients (n = 3527) were collected but analyzed for the inpatients aged >15 years (n = 2909) using the World Health Organization’s methodologies. Patient records were divided into four diagnoses groups: surgical, non-surgical, chronic suppurative otitis media (CSOM), and others. Of 2909 inpatients, 51% had surgical diagnoses. An average of 83% of patients in the clean surgery group and more than 75% in the viral and non-infectious groups were prescribed antibiotics. CSOM was the most common diagnosis (31%), where 90% of inpatients were prescribed antibiotics. Overall, third-generation cephalosporins and fluoroquinolones were most commonly prescribed. This study highlights the inappropriate prescribing of antibiotics to patients of clean surgeries, viral infections, and non-infectious groups. The single-prophylactic dose of antibiotic for clean-contaminated surgeries was replaced by the prolonged empirical prescribing. The use of microbiology investigations was insignificant.

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“…In this study duration of administration of antibiotic for prophylaxis was ranging from one day for lap cholecystectomy to 6.33 days for open laparotomy in general surgery and; 2.62 days for tendon/ligament reconstruction to 5.3 days for spine fixation in orthopaedics. Similar results of prolonged duration of AM prophylaxis post-surgery were reported by Nagdeo et al, Hosoglu S et al and Kulkarni et al 13,16,17 One of the factors ensuring better antimicrobial prophylaxis practices is to administer the drug in the right time, if not, may lead to suboptimal levels of the drug in the plasma, making the surgical site susceptible for development of infection post-surgery. According to both ICMR 2017 and CPGAS 2013 recommendations, the timing of AM administration for prophylaxis should be ideally 30-60 minutes prior to surgery.…”

Section: Discussionsupporting

confidence: 75%

“…Administration of AM for a long duration will not provide any extra benefits, rather it will lead to extra burden in terms of cost and unnecessary side effects like toxicity and development of resistance. 15,16 Though the best possible shortest duration of AM prophylaxis is unknown, most of the guidelines including the ICMR and the CPGAS suggest either single dose or duration exceedingly not more than 24 hours for majority of the surgical procedures. In this study duration of administration of antibiotic for prophylaxis was ranging from one day for lap cholecystectomy to 6.33 days for open laparotomy in general surgery and; 2.62 days for tendon/ligament reconstruction to 5.3 days for spine fixation in orthopaedics.…”

Section: Discussionmentioning

confidence: 99%

Compliance of surgical antimicrobial prophylaxis practices in the departments of general surgery and orthopaedics at a tertiary care centre in India

et al. 2020

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Background: Antimicrobial (AM) prophylaxis is one of the major interventions to prevent surgical site infections. The guideline recommendations are meant for helping the surgeons to select the rationale and effective approach while. This study aimed to assess the compliance of surgical AM prophylaxis in terms of choice of antibiotic, duration and timing of administration using standard international and national guidelines.Methods: A prospective observational study was done in General Surgery and Orthopaedics over a period of one year. All the relevant data was collected and analysed. Results were then compared with standard Clinical Practice Guidelines (CPGAS-2013 and ICMR-2017).Results: In terms of choice of AM, 31.32% of the cases from general surgery and 97.59% of the cases from orthopaedics according to ICMR 2017 guidelines; 28.91% of the cases from general surgery and none of the cases from orthopaedics according to CPGAS 2013 guidelines were found to be compliant. In terms of duration of prophylaxis, 28.91% and 22.89% of the cases from general surgery were found to be compliant to ICMR 2017 and CPGAS 2013 guidelines respectively; but none of the cases from orthopaedics were compliant to either of the guidelines. Timing of administration was found to be compliant with the guidelines in both the departments. Conclusions: Surgical prophylaxis practices were found to be partially compliant with the guidelines in the selected departments.

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Effects of an Educational Module in Rationalizing Surgical Prophylaxis

Cited by 7 publications

References 11 publications

Diagnose-Specific Antibiotic Prescribing Patterns at the Otorhinolaryngology Inpatient Departments of Two Private Healthcare Facilities in Central India: A Five Year Observational Study

Diagnose-Specific Antibiotic Prescribing Patterns at the Otorhinolaryngology Inpatient Departments of Two Private Healthcare Facilities in Central India: A Five Year Observational Study

Diagnose-Specific Antibiotic Prescribing Patterns at Otorhinolaryngology Inpatient Departments of Two Private Sector Healthcare Facilities in Central India: A Five-Year Observational Study

Compliance of surgical antimicrobial prophylaxis practices in the departments of general surgery and orthopaedics at a tertiary care centre in India

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