title: Antibiotic prescribing in women during and after delivery in a non-teaching, tertiary care hospital in Ujjain, India: a prospective cross-sectional study.
abstract: OBJECTIVE
  Antibacterial drugs (hereafter referred to as antibiotics) are crucial to treat infections during delivery and postpartum period to reduce maternal mortality. Institutional deliveries have the potential to save lives of many women but extensive use of antibiotics, add to the development and spread of antibiotic resistance. The aim of this study was to present antibiotic prescribing among inpatients during and after delivery in a non-teaching, tertiary care hospital in the city of Ujjain, Madhya Pradesh, India.
  
  
  METHODS
  A prospective cross-sectional study was conducted including women having had either a vaginal delivery or a cesarean section in the hospital. Trained nursing staff collected the data on daily bases, using a specific form attached to each patient file. Statistical analysis, including bivariate and multivariable logistic regression was conducted.
  
  
  RESULTS
  Of the total 1077 women, 566 (53%) had a vaginal delivery and 511 (47%) had a cesarean section. Eighty-seven percent of the women that had a vaginal delivery and 98% of the women having a cesarean section were prescribed antibiotics. The mean number of days on antibiotics in hospital for the women with a vaginal delivery was 3.1 (±1.7) and for the women with cesarean section was 6.0 (±2.5). Twenty-eight percent of both the women with vaginal deliveries and the women with cesarean sections were prescribed antibiotics at discharge. The most commonly prescribed antibiotic group in the hospital for both the women that had a vaginal delivery and the women that had a cesarean section were third-generation cephalosporins (J01DD). The total number of defined daily doses (DDD) per100 bed days for women that had a vaginal delivery was 101, and 127 for women that had a cesarean section.
  
  
  CONCLUSIONS
  The high percentage of women having had a vaginal delivery that received antibiotics and the deviation from recommendation for cesarean section in the hospital is a cause of concern. Improved maternal health and rational use of antibiotics are intertwined. Specific policy and guidelines on how to prescribe antibiotics during delivery at health care facilities are needed. Additionally, monitoring system of antibiotic prescribing and resistance needs to be developed and implemented.
authors.affiliation: Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, SE 171 77, Stockholm, Sweden.|Department of Pharmacology, R. D. Gardi Medical College, Ujjain, (M P) 456010, India.
authors.forename: Megha
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
authors.forename: Linda
authors.initials: L
authors.lastname: Sanneving
authors.affiliation: Department of Obstetrics and Gynecology, R. D. Gardi Medical College, Ujjain, (M P) 456010, India.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Mahadik
authors.affiliation: Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
authors.forename: Michele
authors.initials: M
authors.lastname: Santacatterina
authors.affiliation: Department of Pharmacology, R. D. Gardi Medical College, Ujjain, (M P) 456010, India.
authors.forename: Suryaprakash
authors.initials: S
authors.lastname: Dhaneria
authors.affiliation: Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, SE 171 77, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Stålsby Lundborg
keywords: Antibiotic prescribing; Cesarean section; India; Madhya Pradesh; Non-teaching hospital; Ujjain; Vaginal delivery
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