Prophylactic antibiotic prescription for cesarean section

Abstract

Objectives. To assess the use of prophylactic antibiotics for cesarean section, and to identify factors associated with a doctor's intraoperative prescription. Design. A hospital-based, cross-sectional study. Study participants. All 967 medical records of women undergoing cesarean section from January 1998 to February 1999 in a university hospital, Southern Thailand. Main measures. Independent variables consisted of patient and doctor factors. The outcome variable was whether any antibiotics were given intraoperatively. Multivariate logistic regression with random effects was used to identify factors associated with the doctor's prescription. Results. Prophylactic antibiotics were prescribed in 82% of all patients. One hundred and eighty-eight patients (21%) received antibiotics postoperatively. Of the patients receiving intraoperative antibiotics after cord clamping, 8% received only a single dose and 53% received an additional postoperative prescription. The most commonly used antibiotic was ampicillin. Intraoperative prescription was significantly associated with longer duration of ruptured membranes, higher number of vaginal examinations and doctors' age. Doctors aged 30-39 years had three and seven times the likelihood of prescribing intraoperative antibiotics compared with their younger and older colleagues, respectively. Conclusions. Administration of single-dose prescriptions was still an uncommon practice. Prophylaxis was given more commonly to patients with well known risks for infection, and was given by doctors aged 30-39 years.