An Assessment of Antimicrobial Prescription Pattern among Surgical Patients: A Hospital Based Cross Sectional Descriptive Study

  • Bikash Bahadur Rayamajhi Nepalese Army Institute of Health Sciences, Sanobharang, kathmandu
  • Anjan Khadka Assistant Professor, Department of Pharmacology, Nepalese Army Institute of Health Sciences (NAIHS), Sanobharyang, Kathmandu, Nepal
  • Santosh Khadka Assistant Professor, Department of Anesthesiology, Nepalese Army Institute of Health Sciences (NAIHS), Sanobharyang, Kathmandu, Nepal
  • Seejana Singh Maharjan Medical Officer, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal


Antimicrobials are used before, during and after surgery to prevent infections to decrease the duration of hospital stay, increase surgical outcomes and reduce health-related costs. There is inadequate evidence to determine the effective group of antimicrobials to be used in surgical prophylaxis in our settings.
A hospital-based cross-sectional descriptive study involving antimicrobial prescriptions pattern among 223 surgical patients was undertaken. Information on patient’s demographic variables, diagnosis, type of surgery and wound, perioperative antimicrobial use, postoperative complications and number of antimicrobials prescribed from the essential medicine list were recorded. The antibiotic prescription patterns were assessed based on a comparison with international and national guidelines.
 Among 223 patients, males were predominant with an overall mean age of 42.77 years. The total number of diagnoses was 30, the commonest being appendicitis (21.52%), urinary stone disease (15.69%), hernia (13.90%) and cholelithiasis (11.65%). The common surgeries performed were emergency appendectomy, hernioplasty and laparoscopic cholecystectomy. Eighteen types of drugs from seven different antimicrobial groups were used perioperatively, out of which 73% and 83% were prescribed based on international and national guidelines respectively.
The most common antimicrobial used was third-generation cephalosporin. The postoperative antimicrobial rate was found higher compared to preoperative and intraoperative prescriptions and for a longer duration compared to national and international guidelines.


1. Bass BL, Garbey M. A road map for computational surgery: challenges and opportunities. J Comput Surg. 2014;1(1):2. doi:
2. Zhou C, Chen X, Wu L, Qu J. Distribution of drug-resistant bacteria and rational use of clinical antimicrobial agents. Exp Ther Med. 2016;11(6):2229–32. doi:
3. Lambrini K, Kotsiftopoulos CH, Papageorgiou M, Iliadis CH, Monios A. The rational use of antibiotics medicine. J Healthc Commun. 2017;2(3):27. doi:
4. Saini N, Saini V, Mehta PW. Misuse of antibiotics: a potential threat. IOSR J Dent Med Sci. 2014;13(7):68–72. doi:
5. Matsuda S, Ikawa F, Hideo OH, et al. Questionnaire Survey Regarding Prevention of Surgical Site Infection after Neurosurgery in Japan: Focus on Perioperative Management and Administration of Surgical Antibiotic Prophylaxis. Neurologia medico-chirurgica. 2019 Jun;59(6):197. doi:
6. Dellinger EP. Prophylactic antibiotics: administration and timing before operation are more important than administration after operation. Clin Infect Dis. 2007;44(7):928–30. doi:
7. Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the national surgical infection prevention project. Clin Infect Dis. 2004;38(12):1706–15. doi:
8. Satti M, Hamza M, Sajid Z, et al. Compliance Rate of Surgical Antimicrobial Prophylaxis and its Association with Knowledge of Guidelines Among Surgical Residents in a Tertiary Care Public Hospital of a Developing Country. Cureus. 2019;11(5): e4776. doi:
9. Kwak YG. Appropriate use of surgical antibiotics prophylaxis. J Korean Med Sci. 2019; 34(17):e136
doi: 10.3346/jkms.2019.34.e136
10. Courtney L, Nankervis JM, James R, Rajkhowa A, Peel T, Thursky K. Surgical antimicrobial prophylaxis. Aust Prescr. 2017; 40(6):225-29. doi: 10.18773/austprescr.2017.073
11. National list of essential medicines. Department of drug administration, Ministry of health, Government of Nepal. 5th revision. 2016. Available from:
12. Sane RM, Shahani SR, Kalyanshetti AA. Antibiotic prescription pattern in surgical wards of MGM Hospital, Kamothe. Int J Infect. 2018; 5(1):e57914. doi:
13. Patel KM, Jadav SD, Parmar AP, Trivedi H. Drug prescribing pattern in surgical wards of a tertiary care hospital in western part of India. International Journal of Basic and Clinical Pharmacology. 2018; 7(8): 1587-91. doi: 2003.ijbcp20183028.
14. Alemkere G. Antibiotic usage in surgical prophylaxis: A prospective observational study in the surgical ward of Nekemte referral hospital. Journal Plos one. 2018; 13(9):e0203523. doi:
15. Giri BR, Pant HP, Shankar PR, Sreeramareddy CT, Sen PK. Surgical site infection and antibiotics use pattern in a tertiary care hospital in Nepal. J Pak Med Assoc. 2008; 58(3):148-50.
16. Alamrew K, Tadesse TA, Abiye AA, Shibeshi W. Surgical antimicrobial prophylaxis and incidence of surgical site infections at Ethiopian tertiary-care teaching hospital. Infectious Disease research and Treatment. 2019; 12:1-7. doi:
17. Murri R, Belvis AG, Fantoni M et al. Impact of antibiotic stewardship on perioperative antimicrobial prophylaxis. Internal Journal for Quality in Health Care. 2016; 28(4):502-7. doi:
18. Viola GM, Rolston KV, Butler C et al. Evaluation of current perioperative antimicrobial regimens for the prevention of surgical site infections in breast implant-based reconstructive surgeries. Plast Reconstr Surg Glob Open. 2019; 7:e2342. doi:
19. Eriksen HM, Chugulu S, Kondo S, Lingaas E. Surgical site infection at Kilimanjaro Christian medical centre. J Hosp Infect. 2003; 55:14-20. doi:
20. Mwita JC, Souda S, Magafu MG, Massele A, Godman B, Mwandri M. Prophylactic antibiotics to prevent surgical site infections in Botswana: findings and implications. Hospital practice. 2018 May 27;46(3):97-102. doi:
21. Fukatsu K, Saito H, Matsuda T, Ikeda S, Furukawa S, Muto T. Influences of type and duration of antimicrobial prophylaxis on an outbreak of methicillin-resistant staphylococcus aureus and on the incidence of wound infection. Arch Surg. 1997; 132(12):1320-5. doi:
22. Dancer SJ. The problem with cephalosporins. J Antimicrob Chemother. 2001; 48(1):463-78. doi:
23. Raut B, Khadka A, Borah RN. Prescription Patterns of Antimicrobial Drugs in Hospitalized Patients in Tertiary Care Hospital of Kathmandu. Medical Journal of Shree Birendra Hospital. 2016 Jul 5;15(1):52-60. doi:
24. Eskicioglu C, Gagliardi AR, Fenech DS, Forbes SS, McKenzie M, McLeod RS, Nathens AB. Surgical site infection prevention: a survey to identify the gap between evidence and practice in University of Toronto teaching hospitals. Canadian Journal of Surgery. 2012 Aug;55(4):233. doi:
How to Cite
RAYAMAJHI, Bikash Bahadur et al. An Assessment of Antimicrobial Prescription Pattern among Surgical Patients: A Hospital Based Cross Sectional Descriptive Study. J Soc Surg Nep, [S.l.], v. 24, n. 1, p. 23-27, dec. 2021. ISSN 2392-4772. Available at: <>. Date accessed: 28 jan. 2022.