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

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.

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.

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.

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.

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.