Evaluation of Surgical Antibiotic Prophylaxis Guideline Adherence: A Cross-Sectional Study of Two Iranian Teaching Hospitals

Abstract

Background: Prophylactic antibiotics can reduce post-surgical infection rates, but their improper use in surgery remains a significant concern. This misuse leads to adverse drug reactions, increased bacterial resistance, and unnecessary hospital costs. Objectives: This study aimed to examine and compare prophylactic antibiotic prescribing practices in general surgery departments at two Tehran university hospitals, in relation to established guidelines. Methods: A cross-sectional study was conducted on 194 surgical patients. Data collection included demographic details, surgery type, and antibiotic prophylaxis protocols, covering medication type, dosage, pre-surgical timing, and prophylaxis duration. Results: The study included 27.8% clean surgeries and 72.2% clean-contaminated surgeries. Cefazolin was the primary antibiotic prescribed. According to the American Society of Health-System Pharmacists (ASHP) treatment guidelines, 10% of patients received antibiotics without proper indication. Among the 90 cases requiring antibiotic prophylaxis, appropriate antibiotic selection occurred in 39.0% of cases at Rasul Akram Hospital and 41.5% at Firouzgar Hospital. In these cases, errors were noted in dosing (79.8%), pre-operative timing (97.4%), and administration protocol (100%). Only 33% of cases followed the optimal prophylaxis duration. Conclusions: These hospitals require an evidence-based antibiotic prescription program that adheres to clinical guidelines and includes close monitoring of implementation. Regular training and review of clinical guidelines are essential for all healthcare professionals.