Current status of prophylactic use of antimicrobial agents for cesarean section in Thailand

To evaluate actual practices and physician reasons for variation in prophylactic use of antimicrobial agents for cesarean section (CS).

The study combined a survey of 2726 medical records and an interview of 50 practicing physicians at the obstetric departments of a university, a regional and a general hospital in Songkhla Province, Southern Thailand.

Practices that were consistent with systematic reviews were use in 94%, prescription after cord clamping in 86%, and choosing ampicillin in 91%, because physicians believed in the advantages of these practices. Indications for prophylactic use ranged from routine use for all cases to selective use for indicated cases such as ruptured membranes, vaginal examinations, labor, maternal obesity, or unplanned CS. Single-dose practice was varied greatly across hospitals, from 9% to 84%. The reasons given by physicians for a multiple-dose regimen were personal experience in this regimen and belief in its superiority under their local conditions. This practice was less common where the hospital had practice recommendations.

Not all evidence-based knowledge is adopted in practice. The prophylactic use of antimicrobial agents for CS varies among physicians. Past experience and personal beliefs in the limitation of research generalizability are the barriers to such adoption.