Effect of interventions on prescribing of antimicrobials for prophylaxis in obstetric and gynecologic surgery

The effect of interventions on the conformity of physicians with guidelines for the appropriate use of antimicrobial prophylaxis in obstetric and gynecologic surgery is reported. Guidelines on the appropriate use of antimicrobial prophylaxis in common obstetric and gynecologic surgical procedures were developed in late 1986 by the antibiotic subcommittee at a 1100-bed tertiary-care teaching facility. The guidelines were not adopted immediately by the department of obstetrics and gynecology (OB-GYN). An audit of the medical records of women who had received antimicrobial therapy for abdominal and vaginal hysterectomies and emergency cesarean sections during January through March 1987 showed that cefoxitin was used in 68% of the cases instead of the less expensive and equally efficacious cefazolin as recommended in the guidelines. The projected annual cost of this nonconformity was $26,500. After the subcommittee informed the physicians about the guidelines and the audit results, the OB-GYN department adopted the guidelines. A second audit performed one year later showed that cefazolin was used in the recommended manner in 93% of cases; projected annual cost savings were $25,000. Both audits showed that prophylactic treatment was inappropriately prolonged in 6% of cases. Substantial cost savings were realized by minimizing inappropriate antimicrobial drug use through efforts to promote rational and cost-effective therapy.