Antimicrobial Prescribing Practices for Surgical Prophylaxis in Caesarean Sections at Kawempe National Referral Hospital, Kampala, Uganda

Abstract

ABSTRACT Background and Aims Antimicrobial resistance (AMR) is a global public health threat, especially in developing countries, where limited antimicrobial stewardship programs contribute to inconsistent prescribing practices for Caesarean section (CS) surgical prophylaxis. This study aimed to investigate physicians' knowledge and prescribing practices related to CS surgical antibiotic prophylaxis at Kawempe National Referral Hospital (KNRH) in Uganda. Methods An anonymous electronic survey was conducted among 200 prescribing healthcare providers, including obstetricians, gynecologists, residents, fellows, medical officers, and interns involved in CS procedures over 4 months in 2021. The survey assessed demographic characteristics, knowledge of AMR, stewardship practices, and adherence to CS antibiotic prophylaxis guidelines. Participation was voluntary and confidential. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 27, with a p ‐value < 0.05 considered statistically significant. Results The most commonly chosen antibiotic was ceftriaxone, followed by metronidazole, either alone or in combination, both of which are not recommended according to World Health Organization (WHO) guidelines for CS prophylaxis. Most antibiotics were administered 15 to 60 min prior to surgery, which is also not in alignment with recommendations. Overall, the study revealed limited compliance with national and international guidelines on antibiotic prescription for CS prophylaxis among healthcare professionals, particularly regarding antibiotic choice, timing of administration, frequency, and dosage. Conclusion The study reveals major gaps between recommended and actual antimicrobial prophylaxis practices for CS at KNRH. Despite clinicians’ awareness of AMR, systemic barriers such as poor microbiological testing and reliance on peer advice hinder adherence. These findings reflect on the importance of policy development and the implementation of antimicrobial stewardship programs in Uganda to improve prescribing practices among healthcare providers.