Antibiotic Prescribing Patterns and Adherence to Institutional Guidelines Among Adult Surgical Inpatients: A Cross-Sectional Study

Abstract

Background: Antibiotics are widely prescribed in surgical wards for prophylaxis and treatment of infections, but inappropriate use may contribute to antimicrobial resistance. This study assessed antibiotic utilization patterns and factors associated with compliance with institutional prescribing guidelines. Methods: This prospective observational study was conducted in the Department of General Surgery over six months. A total of 250 adult patients receiving at least one systemic antibiotic were recruited using consecutive sampling. Clinical and antibiotic-related data were extracted from medical records. Data were analyzed using SPSS version 23.0. Associations with guideline compliance were assessed using chi-square tests, and multivariable logistic regression identified independent predictors of non-compliance. Results: The mean age was 46.8 ± 15.2 years, and 148(59.2%) of participants were male. Emergency admissions accounted for 141 (56.4%). Therapeutic antibiotic use 134 (53.6%) was more common than prophylactic use 116 (46.4%). Combination therapy was prescribed in 148 (59.2%) of patients, while 204 (81.6%) of prescriptions were empirical and 88.4% were intravenous. Ceftriaxone 146 (58.4%) and metronidazole 131 (52.4%) were most common. Therapy lasted 2–5 days in 109(43.6%) of patients. Overall, 197 (78.8%) of prescriptions were compliant. Bivariate analysis showed no significant associations with demographic or treatment variables. Multivariable analysis showed lower odds of non-compliance with therapeutic use (adjusted OR=0.52, 95% CI: 0.28–0.96, p=0.038) and empirical therapy (adjusted OR=0.44, 95% CI: 0.21–0.91, p=0.026). Conclusion: Antibiotic prescribing was predominantly empirical and guideline-compliant. Strengthening antimicrobial stewardship and guideline-based prescribing may further improve rational antibiotic use.