Iranian surgeons’ compliance with the American Society of Health-System Pharmacists guideline: antibiotic prophylaxis in private versus teaching hospitals of Shiraz, Iran

OBJECTIVES To assess compliance with the American Society of Health-System Pharmacists (ASHP) guidelines of prophylactic antibiotic use in private hospitals in Shiraz, Iran. METHODS This cross-sectional study was performed using prospective data gathered from April to September 2010 in the surgical wards of all private hospitals in Shiraz. Administrative data, patient characteristics, and antibiotic prophylaxis criteria were collected. Adherence to five criteria according to ASHP guidelines was evaluated: justification of the use of prophylactic antibiotics, appropriateness of the agent, dose, initiation time, and duration of the agent's effect. Only if all of the above criteria were fulfilled would the individual be labeled as completely compliant. We used descriptive analysis, including frequencies, to evaluate the results. RESULTS From April to September 2010, 365 patients from 63 surgical wards of eleven private hospitals were enrolled in our study. Prophylactic antibiotics were inappropriately given to 64.6% of patients. Twenty out of 26 patients did not receive an appropriate course of antibiotics. In cases requiring antibiotic prophylaxis per ASHP guidelines, antibiotic choice was concordant in 32 (25.4%) out of 126 procedures. In cases that required and received prophylactic antibiotics, the duration and initiation time of prophylaxis were concordant with the guidelines for 37 (29.4%) and 77 (61.1%) cases, respectively. The overall compliance with ASHP guidelines was 10.13%. CONCLUSIONS Our study revealed that in private hospitals in Shiraz, Iran, approximately 90% of patients received inappropriate surgical prophylaxis. Practical measures to improve the implementation of guidelines are urgently needed.