International Journal of Clinical Pharmacy

, Volume 35, Issue 1, pp 149–153 | Cite as

An audit of prophylactic surgical antibiotic use in a Sudanese Teaching Hospital

  • Abubaker Ibrahim ElburEmail author
  • Mirghani Abd El Rahman Yousif
  • Ahmed Sayed Ahmed ElSayed
  • Manar Elsheikh Abdel-Rahman
Short Research Report


Background Antibiotic prophylaxis is effective at reducing the risk of postoperative infection for nearly all types of surgery. Objective To audit the use of prophylactic antibiotics for elective surgery. Setting Khartoum Teaching Hospital, Sudan, a 1,000 bed tertiary level hospital. Method A prospective study was conducted over a 9 month period; patients admitted for elective surgery were included consecutively. Main outcome measure The use and administration of prophylactic antibiotics for elective surgery. Results A total of 1,768 patients with mean age 37.8 ± 14 years were recruited (females, 83.3 % of total) who underwent 1,814 surgical interventions. Of these 1,277 (70.4 %) of procedures were clean-contaminated. A total of 1,758 patients (99.4 % of total) received antibiotics for prophylaxis; 1,730 patients (97.9 %) were given antibiotics in the operating room; for 1,288 (74.5 %) of cases the antibiotics were considered ‘recommended’, while for 442 (25.5 %) they were not. Out of the patients for whom prophylaxis was recommended and was given, 725 (56.3 %) of patients received a broad spectrum antibiotic or unnecessary combination, 913 (70.9 %) received a sub-therapeutic dose, 120 (9.3 %) were given the first preoperative dose within the proper time window, and 1,250 (97 %) of patients had an extended duration of prophylaxis. Compliance with all stated criteria was achieved in only 47 (2.7 %) of observed prescriptions. Conclusion This audit showed a wide gap between international standards and local practices; the authors call for urgent action to correct this situation through the development and implementation of local clinical guidelines.


Antibiotic prophylaxis Drug utilization review Sudan Surgery Surgical wound infection 



The authors greatly appreciate the co-operation by the staff members of Khartoum Teaching Hospital who participated at different stages of this study.


Part of this work was financially supported by Amipharma Laboratories, Pharma Exir Company, and Tabouk Medical Company, Sudan.

Conflicts of interest

The funders did not have any influence on the content or the presentation of this manuscript.


  1. 1.
    Hampson FG, Ridgway EJ. Prophylactic antibiotics in surgery. Surgery. 2005;23(8):290–3.Google Scholar
  2. 2.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20(4):250–78.PubMedCrossRefGoogle Scholar
  3. 3.
    Nicolas RL. Preventing surgical site infections: a surgeon’s perspective. Emerg Infect Dis. 2001;7(2):220–4.CrossRefGoogle Scholar
  4. 4.
    Fonseca SN, Kunzle SR, Junqueira MJ, Nascimento RT, de Andrade JI, Levin AS. Implementing 1-dose antibiotic prophylaxis for prevention of surgical site infection. Arch Surg. 2006;141:1109–13.PubMedCrossRefGoogle Scholar
  5. 5.
    Bratzler DW, Houck PM. Surgical Infection Prevention Guidelines Writers Workgroup. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004;38:1706–15.PubMedCrossRefGoogle Scholar
  6. 6.
    Scottish Intercollegiate Guidelines Network Antibiotic prophylaxis in surgery. A national clinical guideline. July 2008. Available at last accessed, April, 25, 2012.
  7. 7.
    American Society of Health—System Pharmacists (ASHP). ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 1999;56(18):1839–88.Google Scholar
  8. 8.
    Vessal G, Namazi S, Davarpanah MA, Foroughinia F. Evaluation of prophylactic antibiotic administration at the surgical ward of a major referral hospital, Islamic Republic of Iran. East Mediterr Health J. 2011;17(8):663–8.PubMedGoogle Scholar
  9. 9.
    Kalman D, Barriere SL. Review of the pharmacology; pharmacokinentics and clinical use of cephalosporin. Tex Heart Inst J. 1990;17(3):203–15.PubMedGoogle Scholar
  10. 10.
    Martin C, Pourriat JL. Quality of perioperative antibiotic administration by French anesthetists. J Hosp Infect. 1998;40(1):47–53.PubMedCrossRefGoogle Scholar
  11. 11.
    Takesue Y, Mikamo H, Arakawa S, Suzuki K, Sakamoto H, Okubo T, et al. Guidelines for implementation of clinical studies on surgical antimicrobial prophylaxis. J Infect Chemother. 2008;14:172–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Weber WP, Marti WR, Zwahlen M, Misteli H, Rosenthal R, Reck S, et al. The timing of surgical antimicrobial prophylaxis. Ann Surg. 2008;247(6):918–26.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  • Abubaker Ibrahim Elbur
    • 1
    Email author
  • Mirghani Abd El Rahman Yousif
    • 1
  • Ahmed Sayed Ahmed ElSayed
    • 2
  • Manar Elsheikh Abdel-Rahman
    • 3
  1. 1.Department of Clinical Pharmacy, College of PharmacyTaif UniversityAl-HaweiahKingdom of Saudi Arabia
  2. 2.Department of Cardiothoracic SurgeryAlshaab Teaching HospitalKhartoumSudan
  3. 3.Faculty of Mathematical SciencesUniversity of KhartoumKhartoumSudan

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