evaluation of surgical antibiotic prophylaxis guideline adherence: a cross-sectional study of two iranian teaching hospitals

Background: prophylactic antibiotics can reduce post-surgical infection rates, but their improper use in surgery remains a significant concern. this misuse leads to adverse drug reactions, increased bacterial resistance, and unnecessary hospital costs. objectives: this study aimed to examine and compare prophylactic antibiotic prescribing practices in general surgery departments at two tehran university hospitals, in relation to established guidelines. methods: a cross-sectional study was conducted on 194 surgical patients. data collection included demographic details, surgery type, and antibiotic prophylaxis protocols, covering medication type, dosage, pre-surgical timing, and prophylaxis duration. results: the study included 27.8% clean surgeries and 72.2% clean-contaminated surgeries. cefazolin was the primary antibiotic prescribed. according to the american society of health-system pharmacists (ashp) treatment guidelines, 10% of patients received antibiotics without proper indication. among the 90 cases requiring antibiotic prophylaxis, appropriate antibiotic selection occurred in 39.0% of cases at rasul akram hospital and 41.5% at firouzgar hospital. in these cases, errors were noted in dosing (79.8%), pre-operative timing (97.4%), and administration protocol (100%). only 33% of cases followed the optimal prophylaxis duration. conclusions: these hospitals require an evidence-based antibiotic prescription program that adheres to clinical guidelines and includes close monitoring of implementation. regular training and review of clinical guidelines are essential for all healthcare professionals.