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Updated: Nov 15, 2025

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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The Impact of Antimicrobial Stewardship Program on Injudicious Use of Cefuroxime

Ann L Arulappen1,2, Monica Danial3, Norliza Haron2

  • 1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Georgetown, Malaysia.

Frontiers in Pharmacology
|March 5, 2021
PubMed

Insights

Antimicrobial stewardship programs significantly reduced cefuroxime use and surgical site infections. Adherence to guidelines improved, demonstrating the impact of stewardship on optimizing perioperative antimicrobial prophylaxis (PAP).

Area of Science:

  • Infectious Diseases
  • Clinical Pharmacy
  • Surgical Infections

Background:

  • Antimicrobial stewardship (AMS) programs are crucial for optimizing antibiotic use.
  • Perioperative antimicrobial prophylaxis (PAP) requires careful management to prevent resistance and infections.
  • Cefuroxime injection is commonly used for PAP, necessitating evaluation of its prescribing patterns.

Purpose of the Study:

  • To assess the impact of an AMS program on cefuroxime injection prescribing for PAP.
  • To analyze changes in cefuroxime usage, guideline compliance, surgical site infections (SSIs), and costs.
  • To evaluate the effectiveness of interventions in improving PAP quality.

Main Methods:

  • Retrospective study conducted in Malaysia involving 1,601 patients.
  • Analysis of cefuroxime usage (DDD/100 procedures) and administration duration before and after AMS intervention.
  • Assessment of compliance with local PAP guidelines and rates of surgical site infections.

Main Results:

  • Cefuroxime usage decreased from 202 to 144 DDD/100 procedures (p < 0.05).
  • Prolonged PAP administration dropped from 94.4% to 30.3% (p < 0.001).
  • Guideline compliance increased from 53% to 94.3% (p < 0.001), and SSIs reduced from 17.0% to 9.0%.

Conclusions:

  • AMS interventions effectively optimized cefuroxime prescribing for PAP.
  • Improved PAP quality led to reduced SSIs and significant cost savings.
  • Maintaining high standards of PAP is essential for effective antimicrobial use and patient outcomes.
Keywords:
antimicrobial stewardshipcefuroximedefined daily doseinjudiciousperioperative antimicrobial prophylaxis

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