Do We Need to Change Our Antibiotic Prescription Practices?

Introduction

Antibiotic prophylaxis is used all over the world to reduce the postoperative infection but one thing always questionable whether we are overusing the antibiotics in the postoperative period? Many a clinical practices are still using postoperative antibiotic for seven days. There is frequent change in the antibiotic molecule and also different modes of administration are used. Generally they are used form 5-7 days. Excessive use of antibiotics can result in changed gut flora, antibiotic resistant bacteria, adverse reactions and extra cost [1].

Admission to the hospital itself predisposes the patient to infection by certain bacteria that are prevalent in the hospital called as nosocomial infection. Nearly 3-5 % of the postoperative patients develop surgical site infection. This leads to increased cost and duration of stay for the patient [2]. Majority of the surgical procedures were emergency surgeries in the beginning of surgical practice. These procedures needed antibiotic prescription for 5-7 days. But, now a major proportion of surgeries are done on an elective basis and the surgical wounds are clean. These procedures need only single dose antibiotic [3].

Majority of the western set up hospitals do not use postoperative antibiotic. Studies have proven that antibiotic shot given just before the operative procedure is enough to maintain antibiotic level during operation. This is as effective as 5-7 days of postoperative antibiotic treatment [4, 5].

Results

Data was collected for 100 patients retrospectively, 50 belonged to the group who received single dose antibiotic (group 1) while the rest received seven day course (group 2) of antibiotic. The study duration was almost one year. Abdominal hysterectomy was the commonest operative procedures (Graph 1) in both groups (44% in single dose group and 54% in seven day course group (Graph 2)) followed by vaginal hysterectomy (28% in group 1 and 32% in group 2) (Table 1).

Types of operation group

1

12% 4%

Click to enlarge

TAH

$$ = \frac {1}{2} $$

44% VH

12% $$ = \frac {1}{2} $$

Oophorectomy

$$ = \mathrm {L i} + \mathrm {N a} ^ {+} $$

28% Myomectomy

$$ v = v _ {0} \cos \theta $$

Cystectomy

Graph 1: Showing types of operation in the group 1 study.

Types of operation

group2 TAH

4% 2% $$ = \frac {1}{2} $$

$$ = \frac {1}{2} $$

8% $$ \square $$ VH

$$ \square $$ Oophorectom y

54% 32% $$ \mathrm {L i} + \mathrm {H} _ {2} \mathrm {O} = \mathrm {L i O} _ {2} + \mathrm {H} _ {2} \mathrm {S} $$ Myomectomy $$ = \frac {1}{2} $$ Graph 2: Showing types of operation in the group 2 study.

Copyright© Uma P

Table 2: Patient & Operative details. The postoperative complications were 58% in seven- day course antibiotic group while it was 38% in the single day course. Urinary tract infection was the commonest infection in both groups 14-18%. There was no wound dehiscence or burst abdomen in either of the group. There were no mortalities in either group as well (Table 3).

Uma P. Do We Need to Change Our Antibiotic Prescription Practices? J Gynecol 2016, 1(5): 000128.

Surgeon always tries to make sure that the wound infection in the postoperative period is minimal. There are various ways in which it can be done which includes personal hygiene of the patient, sterilization of equipments, ward cleanliness and surgeon’ good surgical practices. Antibiotics were used for infection prophylaxis in 1960’, which considerably reduced the wound infection rate or postoperative infection rate [6, 7]. Judicious use of antibiotic resulted in reduction of infection, but later it became a human tendency to use it for almost any indication or in any situation. This human tendency led tooveruse, which has created even a bigger problem i. e. antibiotic resistance. With increasing antibiotic resistance there is an increased economic burden on the health budget [8, 9]. This comparative study in elective procedures shows that single dose antibiotic prophylaxis (group 1) is even better than seven-dose antibiotic course (group 2). The wound infection rate was 8% in group 1 while 14% in group 2. Similarly the incidences of fever, chest infection and UTI were also lower in group 1. Incidence of secondary haemorrhage was 2 % in the group 1 while 6 % in group 2, both group patients resolved spontaneously, without needing any operative intervention (Table 3). Studies report that postoperative fever is approximately 32-52%, being the commonest. In our study group 1 has 10%, while group 2 had 12% [10].

Conclusions

Our study shows that single dose antibiotic is more effective to seven day course. This comparative study in elective procedures shows that single dose antibiotic prophylaxisis even better than seven-dose antibiotic course. The wound infection rate was 8% in group 1 while 14% in group 2. Similarly the incidences of fever, chest infection and UTI were also lower in group 1. Incidence of Copyright© Uma P

secondary haemorrhage was 2 % in the group 1 while 6 % in group 2, both group patients resolved spontaneously, without needing any operative intervention. This study has small sample size to draw a firm conclusion; a randomized control trial in our set up would give us a better answer. We strictly follow single dose antibiotic in our elective patients’ care and it is much better than seven days antibiotic course on many aspect (as described in result), therefore the author recommends single dose antibiotic in Elective cases and judicious use of antibiotic in emergency cases.

Conflicts of Interest

There is no conflict of interest. Study was ethically approved and consent was taken.