Prescription of prophylactic antibiotics for neurosurgical procedures in teaching hospitals in Iran

Background: To assess the appropriateness of surgical antibiotic prophylaxis in neurosurgical procedures, using the American Society of Health-System Pharmacists (ASHP) guideline as reference, 110 patients were prospectively evaluated. Monitoring surgical antibiotic prophylaxis is crucial in ensuring appropriate use of antimicrobial agents in this setting. This will minimize the consequences of antibiotic misuse such as increased drug antibiotic resistance, adverse events, and higher costs to the institution. Methods: We recruited 110 consecutive patients undergoing clean neurosurgical treatment in 2 hospitals. Data were collected prospectively from patients' medical records between February 2004 and April 2004. The data collection forms for each patient included hospital name, patient demographics, type of surgery, and type of antimicrobial prophylaxis regimen (drug name, dose, interval, route of administration, number of doses and time administered, and duration of administration). Results: Discrepancies about antibiotic selection, duration, and start time of prophylaxis were seen between current administration and the ASHP guideline. The direct cost of prophylactic antibiotics for the 110 procedures was 14 times greater than what it would have cost to administer prophylactic antibiotics adhering to the ASHP guideline (US $802 vs US $59, US $7.29 vs US $0.54 per patient, respectively). This is equivalent to US $6.75 of extra costs per procedure and patient. Conclusion: This study indicates the need for interventions to improve the rational use of antibiotic prophylaxis in Iran to prevent the complications of inappropriate administration of antimicrobials and decrease unnecessary costs.