A retrospective study showing the misuse of prophylactic antibiotics in patients undergoing appendectomy and cholecystectomy

Objective: The aim of this study was to assess the appropriateness of antib iotic prophylaxis in a sample of patients undergoing appendectomy and chole cystectomy. Background: Inappropriate use of antibiotics occurs in all medical specialt ies; incorrect antibiotic prophylaxis for surgical procedures has been show n to be one of the most serious misuses of these drugs. Methods: A retrospective review of antibiotic prophylaxis was conducted in 7 departments of surgery in an urban, public, university-affilliated, 2000- bed Italian general hospital. Prophylaxis was considered appropriate if it was performed at the induction of anesthesia and consisted of a single intr avenous injection of an antibiotic recommended by the guidelines or, accord ing to a less stringent criterion, if limited to 24-hour coverage. The char ts of 138 patients who underwent surgery for appendectomy (n = 55) or chole cystectomy (n = 83) in 1997 were randomly selected for review from a total of 676 patients undergoing the procedures that year. Results: A total of 5 antibiotics were used for prophylaxis in appendectomy and 7 in cholecystectomy. Among the patients given antibiotics prophylacti cally, these drugs were used inappropriately in 63.6% of patients who under went appendectomy and in 75% of those who underwent cholecystectomy. Reason s for inappropriateness were an excessive duration of treatment, incorrect timing of administration, inadequate antibacterial spectrum of the drug use d, and unnecessary combination of 2 antibiotics. Conclusions: In this Italian general hospital, prophylactic use of antibiot ics was inappropriate in the majority of patients undergoing appendectomy o r cholecystectomy.