title: Are local clinical guidelines useful in promoting rational use of antibiotic prophylaxis in caesarean delivery?
abstract: OBJECTIVE
  To identify changes in prescribing patterns of antibiotic prophylaxis in caesarean delivery after introduction of local clinical guidelines. To identify changes in outcomes of prescribing antibiotics following the implementation of local clinical guidelines on antibiotic prophylaxis.
  
  
  METHODS
  University of Belgrade, Medical School, Clinic of Gynaecology and Obstetrics "Narodni front" Belgrade, Serbia.
  
  
  METHODS
  A quantitative retrospective analysis of antibiotic use before (January-June 2005), and following (January-June 2006) implementation of guidelines on antibiotic prophylaxis in two wards. Patients who underwent caesarean section prior to (261) and following (281) introduction of local guidelines, participated in this study.
  
  
  METHODS
  Drug utilization cost presented as the number of DDD/100 bed days/eur, the average duration of hospital stay, number of wound infections.
  
  
  RESULTS
  There was a significant change in prescribing patterns of antibiotic prophylaxis in caesarean section following introduction of local guidelines. The use of ceftriaxone, amikacin and metronidazole decreased (57.47% vs. 11.74%; 9.19% vs. 4.27%; 61.69% vs. 46.26%, respectively). On the other hand, the use of "older" antibiotics such as gentamicin, cefuroxime, cefazolin and ampicillin increased (14.56% vs. 29.18%; 9.2% vs. 17.44%; 9.58% vs. 45.2% and 0% vs. 3.9%, respectively). DDD/100 bed days/eur analysis revealed a 47% decrease of total cost for prophylactic antibiotic treatment in caesarean section following local guideline implementation. In contrast, rate of wound infections and duration of hospital stay were not significantly different in both groups.
  
  
  CONCLUSIONS
  In an attempt to ensure cost-effective prophylactic use of antibiotics in caesarean delivery, local clinical guidelines were introduced. They resulted in changes in prescribing patterns of antibiotics. There was a significant decrease in use of 'third' generation of cephalosporin's whereas the use of "older" antibiotics with proven efficacy and safety increased. In contrast, there was no significant change in treatment outcomes such as wound infection and average hospital stay.
authors.affiliation: Clinic of Gynaecology and Obstetrics Narodni front, Medical School, University of Belgrade, Belgrade, Serbia.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Ristić
authors.forename: Branislava
authors.initials: B
authors.lastname: Miljković
authors.forename: Sandra
authors.initials: S
authors.lastname: Vezmar
authors.forename: Dusan
authors.initials: D
authors.lastname: Stanojević
mesh_terms: D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis / Q000191:economics* / Q000706:statistics & numerical data*; D002585:Cesarean Section; D006801:Humans; D007902:Length of Stay; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D055815:Young Adult