Overview: Several studies have shown antimicrobial usage was non-concordant with clinical practice guidelines for antimicrobial prophylaxis in surgery. However, there have not been any studies related to antimicrobial usage in surgical patients at Ramathibodi Hospital.

Objective: The purpose of this study was to characterize the concordance of antimicrobial surgical prophylaxis with the guidelines and to evaluate appropriateness of antimicrobial use during hospitalization.

Material and Method: We prospectively collected data from 187 surgical patients receiving antimicrobial at three surgical wards, Ramathibodi Hospital between September and December 2016.

Results: There were 159 (85.0%), 129 (69.0%), 36 (19.3%), 147 (78.6%), 136 (72.7%) and 69 (36.9%) patients consistent with indication, drug of choice, dose, timing, re-dosing, and duration, respectively, was concordant with the American Society of Health-System Pharmacists (ASHP) 2013 guideline. Only orthopedic surgery was a significant factor for non-concordance in term of duration (odd ratio [OR] = 3.966, p<0.001, 95% confidence interval [CI] 1.828 to 8.606). Moreover, only 5.9% of patients had appropriate indications for prescribing antimicrobial as home medications.

Conclusion: Antimicrobial use for surgical prophylaxis was highly correlated with ASHP 2013 guideline, except for the dose and the duration aspects. However, overall antimicrobial prescriptions in surgical and orthopedic wards were not entirely concordant with the guidelines. Interventions to improve guideline concordance of antimicrobial surgical prophylaxis and to decrease unnecessary antimicrobial prescriptions are required.

Keywords: Antimicrobial prophylaxis, Surgery, Surgical prophylaxis, Antibiotic