Evidence on antibiotic prophylaxis for cesarean section alone is not sufficient to change the practices of doctors in a teaching hospital.
OBJECTIVE
To assess the pattern of prophylactic antibiotic use in cesarean sections, identify factors associated with single-dose prescriptions as evidence-based best practice, and evaluate the changes in use of single-dose compared with multiple-dose regimens and the variation of use between doctors after dissemination of evidence.


METHODS
An analytical descriptive study was conducted. The medical records of 432 women undergoing cesarean section from April to September 2001 after dissemination of evidence in a teaching hospital in Southern Thailand were reviewed. Use of single-dose prophylactic antibiotic was the main outcome measure. Patterns of prophylactic antibiotics, and factors associated with pregnant women and doctors, were analyzed and compared with baseline data among 463 women undergoing cesarean section in 1998. Multivariate logistic regression with random effects was used for analysis.


RESULTS
After the dissemination of evidence, the rate of single-dose prescriptions increased from 14.2 to 22.4% (P < 0.01), single-dose prescriptions decreased for patients who had experienced longer durations of ruptured membranes, and the timing of the administration of antibiotics improved, but multiple-dose and duration of postoperative prescriptions increased. The variation in prescribing antibiotics between doctors was significant (P < 0.001).


CONCLUSIONS
Knowledge of evidence alone does not improve practices uniformly. Consequently, other interventions are necessary to improve practices.
Liabsuetrakul
Tippawan
T
Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand. ltippawa@hotmail.com
Islam
Monir
M
D000328:Adult; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D002585:Cesarean Section; D017723:Drug Utilization Review / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008499:Medical Records; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D012189:Retrospective Studies; D013785:Thailand / Q000453:epidemiology