Practice of Prophylactic Antibiotic for Caesarean Section Among Physicians In Maternity Units in Northern Nigeria

Abstract

Background

Caesarean section is a crucial obstetric intervention, especially in developing countries. However, postoperative infection remains a concern due to the inconsistent use of prophylactic antibiotics.

Objective

The study's objective was to determine the practice of prophylactic antibiotics use for caesarean section among physicians working in maternity units in northern Nigeria.

Material and methods

Medical doctors in Obstetrics and Gynaecology departments across northern Nigeria were sent online self-administered questionnaires to assess their practice of prophylactic antibiotics during caesarean delivery. They were asked about their ages, experiences, professional ranks, practice locations, and the monthly average of cesarean deliveries. The primary outcome was adherence to the WHO recommendation of administering pre-incision antibiotics for caesarean sections. The study also asked whether there was a departmental or hospital-written policy on prophylactic antibiotic use during caesarean delivery.

Results

Of the 315 that responded, only 233 (78.5%) gave routine pre-incision prophylactic antibiotics in all caesarean sections. Of those that give routine prophylaxis, 109(46.9%) gave only one dose, 39(16.7%) will gave two doses, while the remaining 85 (36.4%) gave three or more doses. More than 90% of the respondents would prescribe additional antibiotics aside from the prophylactic dose for a period ranging from 1 to 10 days.

Ceftriaxone was the most common prophylactic antibiotic used by 84.1%, and another 53.5%  use ceftriaxone-sulbactam combination. Amoxicillin + clavulanic acid + metronidazole and amoxicillin + clavulanic acid only were used by 82.3% and 67.1%, respectively. Only 36.7% attested to using cefuroxime. Only 13.7% of the respondents have protocols on prophylaxis for caesarean section in their place of work, and 14.9% know about the antibiotic policy in their hospitals.

Conclusion

The most common prophylaxis antibiotic for caesarean section is ceftriaxone, followed by Amoxicillin + clavulanic acid + metronidazole and amoxicillin + clavulanic acid only, respectively. Almost 4/5^th of doctors give pre-incision antibiotic prophylaxis as recommended by the WHO. However, there is a need for departmental protocols to guide the use of prophylaxis antibiotics in maternity units.