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\def\citeauthor{~Florence~Tabitha,
              ~Mounika~G,
              ~Sai~Varshini~N,
              ~Kranthi~J,
              ~Pushpalatha~B,
              ~Sudhakar~M}
\def\citetitle{\textbf{Perioperative Antibiotic Prophylaxis in a Tertiary Care Hospital: An Observational Study}}
\def\copyrightstmt{This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial- ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.}
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\def\RunningAuthor{Florence Tabitha et al.}
\firstPage{32}
\articleType{Original Article}
\receivedDate{05 Jan 2022}
\acceptedDate{25 Jan 2022}
\revisedDate{24 Jan 2022}
\journalVolume{2}
\journalIssue{1}
\copyrightYear{2022}
\eISSN{2583-0953}
\journalDoi{10.26452/ijcpms.v2i1.265}
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\def\journalTitle{International Journal of Clinical Pharmacokinetics and Medical Sciences}

\title{\textbf{Perioperative Antibiotic Prophylaxis in a Tertiary Care Hospital: An Observational Study}}
\author{Florence~Tabitha\textsuperscript{*},  
            Mounika~G,  
            Sai~Varshini~N,  
            Kranthi~J,  
            Pushpalatha~B, 
            Sudhakar~M~\\[5pt]{Department of Pharmacy Practice, Malla Reddy College of Pharmacy (Affiliated to Osmania University), Dhulapally, Secunderabad, Telangana-500100, India}}

\begin{abstract}
A Retrospective study was conducted for 6 months in a 650 bedded tertiary teaching hospital involving in-patients of the general surgery department. During the research period, 102 participants' data was collected in a specified format from medical case records and drug charts. The acquired data was subjected to descriptive statistics and analysed using Microsoft Excel software. This study involved 57\% females and 43 \% males. The general surgery department (57\%) contributed to most of the cases in our study. The most common surgeries performed were Hernia repair (12.7\%) and Septoplasty (12.7\%). Preoperative antibiotic prophylaxis was prescribed for 87 (85.2\%) subjects. To them Inj. Cefotaxime IV was the most prescribed and 1gm dose was commonly prescribed in 42\% of the participants pre-operatively and 51\% of the participants post-operatively. In the case of a combination of antibiotic usage, it had been found that preoperatively. In 23\% of the samples, Ceftriaxone+Metronidazole was the most often recommended combination. After surgery in 35\% of individuals, cefotaxime+metronidazole was the most usually given combination. Overall compliance with prophylactic antibiotics was following the guidelines of NCDC version 1.0 (2016). The guidelines insisted to prescribe Cefazolin, Ceftriaxone instead of Cefotaxime. The density of antimicrobial use for postoperative antimicrobial prophylaxis was very high. Institutional antibiotic recommendations might be more beneficial, resulting in more acceptability and compliance. Furthermore, active participation and provision of cooperating multidisciplinary teams, which include clinical pharmacists, dispensing pharmacists, and management, can aid in programme quality enhancement. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Preoperative Antibiotic Prophylaxis,\newline Postoperative Antibiotic Prophylaxis,\newline Surgery
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright{\Large$^\ast$}Corresponding Author\par Name:\ Florence~Tabitha~\\ Phone:\ +919000281097~\\  Email:\ flotina58@gmail.com
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\section{Introduction}
The use of antibiotics to prevent infections at the surgical site is known as surgical antibiotic prophylaxis. Surgical antibiotic prophylaxis guidelines were developed to provide surgeons an uniform approach to the reasonable, safe, and effective use of antimicrobial medicines for the prevention of surgical site infections, based on international, national, and local standards. Despite the fact that these recommendations are available, following the established norms is difficult \unskip~\cite{1443641:25188308}.

Primary prophylaxis, secondary prophylaxis (suppression), and eradication are all terms used to describe the prevention of infection. Primary prophylaxis refers to the prevention of initial infection. Secondary prophylaxis refers to the prevention of recurrence or reactivation of a pre-existing infection (e.g., prevention of the recurrence of a latent herpes simplex virus infection). 

The term "eradication" refers to the elimination of a colonised organism in order to avoid infection (for example, removing Methicillin-resistant Staphylococcus Aureus [MRSA] from the first line health care workers) \unskip~\cite{1443641:25188310}.

Infections that arise within 30 days after an invasive operation are known as surgical site infections (SSIs) (or 90 days in case of implanted prosthetics). SSIs are responsible for almost 20\% of all hospital-acquired infections \unskip~\cite{1443641:25188300}. Preoperative antibiotic prophylaxis (PAP) can lower the risk of SSIs by up to 80\% \unskip~\cite{1443641:25188300}. This is due to antibiotics' ability to inhibit the development of contaminating bacteria \unskip~\cite{1443641:25188302}. Reduced morbidity and mortality, a shorter hospital stay, and lower hospital expenditures are all added advantages. Inappropriate surgical prophylactic antibiotic usage, on the other hand, might result in issues such as increased antimicrobial resistance, decreased effectiveness, a variety of side effects, and greater hospital costs \unskip~\cite{1443641:25188296}.

SSIs are the third most often reported nosocomial infection, accounting for 12 percent to 16 percent of all nosocomial infections among hospitalised patients, according to the National Nosocomial Infections Surveillance (NNIS) system. SSI is seen despite advanced infection control practices. 

Antibiotics should be given at the appropriate time to avoid postoperative infections, however this is often ignored. In situations of planned surgery, surgical site infections can be avoided by managing risk factors \unskip~\cite{1443641:25188304}.

Antibiotics were only given post-operatively in the beginning to treat surgical wound infections that had already developed. The notion of antibiotic prophylaxis was established later on. Antibiotics were first given post-operatively for a substantial period, but there was no significant reduction in surgical site infection rates. It was later determined that antibiotics should be given before surgery to prevent wound infection \unskip~\cite{1443641:25188307}.

The use of preoperative systemic antibiotics has significantly reduced wound infection rates. The well-known problems of lengthy antibiotic prophylaxis may be avoided by delivering a single dosage of antibiotic right before surgery and keeping its blood level high only until the patient is back in bed and aware, because there would be no time to inhibit the natural bacteria. Antibiotic prophylaxis is beneficial in preventing surgical site infections. The bacteria most likely to cause infection dictates which antimicrobial agent (AMA) should be used \unskip~\cite{1443641:25188307}.

For surgeries lasting up to 4.10 hours, a single pre-operative antibiotic treatment is adequate. However, during lengthy procedures, more antibiotic doses may be required to maintain medication levels. In the case of persistent or significant intra-operative bleeding, re-administration should be considered. Antibiotic prophylaxis is regarded most effective if given within 30 minutes of the incision \unskip~\cite{1443641:25188311}.

In India, due to the lack of adequate information and guidelines for antimicrobial prophylaxis in surgery, there is a need to generate baseline data on the pattern of use of prophylactic antibiotics. The goal of this study was to determine the current usage of peri-operative antimicrobials among patients having surgical operations in a tertiary care facility \unskip~\cite{1443641:25188297}.

\textbf{Historical Background}

Antibiotic therapy might minimise the wound infection rate in many surgical operations shortly after the advent of the first antimicrobial drugs, penicillin and sulfonamides. In abdominal surgery, penicillin alone was proven to lower infection rates to 10\% from a controlled rate of 25\%.' Antibiotics were shown to be effective in similar research. Prophylactic antibiotics were initially provided in a haphazard manner. There were no guidelines for selecting an agent, dosage, delivery route, or dose timing, and these decisions were frequently left to the surgeon's discretion. Certain issues occurred as antibiotic use grew. Antibiotic resistance has emerged as a growing issue. Penicillin-resistant staphylococci and gram-negative bacilli become increasingly frequent in nosocomial infections. As a result, uncommon illnesses including pseudomembranous colitis and invasive Candida infections have become increasingly frequent. Excess and unnecessary antibiotic prescription trends were blamed heavily. The Joint Commission on Accreditation of Institutions placed a criterion on all of its member hospitals in 1977, stating that antibiotic evaluation must be done by the medical staff. Many hospitals were obliged to reassess their medical staff's antibiotic prescribing and usage habits as a result of this. Since then, antibiotic prophylaxis has been a contentious issue \unskip~\cite{1443641:25188303}.

Based on the relative risks of infection, the American College of Surgeons has classified surgical operations into four categories. Class I~surgical operations are clean procedures in which the operating field is disinfected under controlled conditions. When antibiotics are not taken prophylactically, this class has the lowest prevalence of wound infection, ranging from 1\% to 3\%. In severe circumstances, such as long operational times (over 4 hours) or lapses in sterile procedures, the infection rate might skyrocket. Even when prophylactic antibiotics are used, complicated class I~operations like cardiac bypass surgery can have infection rates of 5\% or greater. Clean contaminated surgical procedures are classified as Class II. The majority of these procedures include cutting across a mucosal membrane with minimum leakage. Hysterectomy and elective intestinal surgery are two examples. The wound infection incidence for class II surgery without antibiotics is significantly greater than for most class I~surgery, ranging from 8\% to 29\% depending on the operation. There is also a lot of diversity in the rates of various surgeons and facilities. Class III surgery is done on inflamed tissue where an infection is already established or if there is substantial viscus leaking. Gross purulence is the sort of purulence observed in Class IV. In class III and IV surgical operations, postoperative wound infection rates are substantial, typically surpassing 20\% to 30\% \unskip~\cite{1443641:25188303}.
    
\section{MATERIALS AND METHODS}
\textbf{Research Design}

A Retrospective observational study.

\textbf{Study Area}

The study was conducted in the surgical departments in Malla Reddy Hospital located in Suraram, Hyderabad. 

\textbf{Sample Size}

102 patients.

\textbf{Study Period}

This study was conducted over 6 months. 

\textbf{Materials Used}

Clinical Proforma.

\textbf{Inclusion Criteria}


  
  \begin{enumerate}
  \item \relax Patients of either gender 
  \item \relax Patients aged 18 years or above 
  \item \relax Inpatient department 
  \item \relax Patients who underwent surgery 
  \item \relax All types of surgeries
  \end{enumerate}
  \textbf{Exclusion Criteria}


  
  \begin{enumerate}
  \item \relax Critically ill patients 
  \item \relax Outpatient department 
  \item \relax Unconscious patient 
  \item \relax Paediatrics 
  \end{enumerate}
  \textbf{Data Analysis }

The data was collected and then analyzed by using the Statistical method- Mode in Microsoft Excel software.

\textbf{Methods of Collection of Data}


  
  \begin{enumerate}
  \item \relax The source data is collected for 6 months who are admitted in the General Surgery and other surgical in-patient departments of Malla Reddy hospital. 
  \item \relax The data was obtained using data collection forms \& questionnaires. 
  \item \relax The data was collected from patient's profile form \& treatment charts 
  \end{enumerate}
  \textbf{Methodology}
  
  \begin{enumerate}
  \item \relax It was held in Malla Reddy Hospital's general surgery department and other surgical departments.
  \item \relax The inclusion and exclusion criteria were used to choose the subjects.
  \item \relax The research lasted for six months.
  \item \relax The data was obtained using data collection forms, questionnaires. The data was collected from patient's profile form \& treatment charts 
  \item \relax The medication adherence was analyzed by following the criteria. 
  \item \relax The different classes of antibiotics prescribed for different types of surgery were analyzed by using data collection forms. 
  \item \relax Statistical analysis was done. 
  \item \relax Results and discussions were done.
  \end{enumerate}
  
    
\section{Results }
In our study, a total of 102 subject's data was collected from the medical record department for six months and the subjects were selected based on inclusion criteria and exclusion criteria. Figure~\ref{f-8cc2ffa42d78}  illustrates the number of subjects based on gender; Figure~\ref{f-ee5e79db22cb}  illustrates specialty-wise distribution of subjects. Surgical procedures performed in patients, distribution of subjects according to single antibiotic usage, Route of administration and doses of cefotaxime pre-operatively were represented in Figure~\ref{f-53517342c484}, Figure~\ref{f-60ebb732b786}  and Figure~\ref{f-ba5772a5034b} respectively.


\bgroup
\fixFloatSize{images/ff87bb4f-b989-486e-b893-9576e6e56f81-upicture1.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/ff87bb4f-b989-486e-b893-9576e6e56f81-upicture1.png}{\includegraphics{images/ff87bb4f-b989-486e-b893-9576e6e56f81-upicture1.png}}{}
\makeatother 
\caption{\boldmath {Number of Subjects Based on Gender}}
\label{f-8cc2ffa42d78}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/cbeb0f59-6e71-4374-bc86-9a8e4e4bb072-upicture2.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/cbeb0f59-6e71-4374-bc86-9a8e4e4bb072-upicture2.png}{\includegraphics{images/cbeb0f59-6e71-4374-bc86-9a8e4e4bb072-upicture2.png}}{}
\makeatother 
\caption{\boldmath {Specialty-Wise Distribution of Subjects}}
\label{f-ee5e79db22cb}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/5cb5befc-4245-4447-bc36-cb70fa8bf969-upicture3.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/5cb5befc-4245-4447-bc36-cb70fa8bf969-upicture3.png}{\includegraphics{images/5cb5befc-4245-4447-bc36-cb70fa8bf969-upicture3.png}}{}
\makeatother 
\caption{\boldmath {Surgical Procedures Performed in Patients}}
\label{f-53517342c484}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/3155b105-361f-423e-9a3c-641fa5343800-upicture4.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/3155b105-361f-423e-9a3c-641fa5343800-upicture4.png}{\includegraphics{images/3155b105-361f-423e-9a3c-641fa5343800-upicture4.png}}{}
\makeatother 
\caption{\boldmath {Distribution of Subjects According to Single Antibiotic Usage (Pre-Operative)}}
\label{f-60ebb732b786}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/3ac9ec04-9e73-4008-84b6-c4fc72c17430-upicture5.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/3ac9ec04-9e73-4008-84b6-c4fc72c17430-upicture5.png}{\includegraphics{images/3ac9ec04-9e73-4008-84b6-c4fc72c17430-upicture5.png}}{}
\makeatother 
\caption{\boldmath {Route of Administration and Doses of Cefotaxime Pre-Operatively}}
\label{f-ba5772a5034b}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/6e3d105c-2816-4b71-ad77-66da892429c2-upicture6.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/6e3d105c-2816-4b71-ad77-66da892429c2-upicture6.png}{\includegraphics{images/6e3d105c-2816-4b71-ad77-66da892429c2-upicture6.png}}{}
\makeatother 
\caption{\boldmath {Distribution of Subjects According to the Combination of Antibiotics Usage (Preoperative)}}
\label{f-794921c6cae4}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/be09b99a-3a87-41df-a9f6-2d18c49a279b-upicture7.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/be09b99a-3a87-41df-a9f6-2d18c49a279b-upicture7.png}{\includegraphics{images/be09b99a-3a87-41df-a9f6-2d18c49a279b-upicture7.png}}{}
\makeatother 
\caption{\boldmath {Distribution of Subjects According to Single Antibiotic Usage}}
\label{f-850ff708ee67}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/fe2ba8e0-e00b-4d63-80a7-e8c3080b85de-upicture8.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/fe2ba8e0-e00b-4d63-80a7-e8c3080b85de-upicture8.png}{\includegraphics{images/fe2ba8e0-e00b-4d63-80a7-e8c3080b85de-upicture8.png}}{}
\makeatother 
\caption{\boldmath {Routes of Administration and Doses of Cefotaxime Post-Operatively}}
\label{f-9ed882a5325a}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/e528d6b9-40e8-4e30-a440-fe017513f659-upicture9.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/e528d6b9-40e8-4e30-a440-fe017513f659-upicture9.png}{\includegraphics{images/e528d6b9-40e8-4e30-a440-fe017513f659-upicture9.png}}{}
\makeatother 
\caption{\boldmath {Distribution of Subjects According to a Combination of Antibiotics Usage (Postoperative)}}
\label{f-88b0bd676804}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/288a88db-cc8c-4125-ace6-9c6abfd1b0bb-upicture10.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/288a88db-cc8c-4125-ace6-9c6abfd1b0bb-upicture10.png}{\includegraphics{images/288a88db-cc8c-4125-ace6-9c6abfd1b0bb-upicture10.png}}{}
\makeatother 
\caption{\boldmath {Duration of Antibiotic Prophylaxis}}
\label{f-3c3f32c3c464}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/45c1072f-4d5c-4ba2-86ea-054e6eb0636b-upicture11.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/45c1072f-4d5c-4ba2-86ea-054e6eb0636b-upicture11.png}{\includegraphics{images/45c1072f-4d5c-4ba2-86ea-054e6eb0636b-upicture11.png}}{}
\makeatother 
\caption{\boldmath {Duration of Antibiotics Prophylaxis Administration Postoperatively in Days}}
\label{f-814ea3e43711}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/93338df2-9934-4bec-91bc-f7082f15bac6-upicture12.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/93338df2-9934-4bec-91bc-f7082f15bac6-upicture12.png}{\includegraphics{images/93338df2-9934-4bec-91bc-f7082f15bac6-upicture12.png}}{}
\makeatother 
\caption{\boldmath {Adherence of Prophylactic Antibiotics to Guidelines}}
\label{f-9614e6c95704}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/0d0ab006-f6a6-464d-b5ad-0d7f48372c32-upicture13.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/0d0ab006-f6a6-464d-b5ad-0d7f48372c32-upicture13.png}{\includegraphics{images/0d0ab006-f6a6-464d-b5ad-0d7f48372c32-upicture13.png}}{}
\makeatother 
\caption{\boldmath {Appropriate Dose of Antibiotic Given Peri-Operatively}}
\label{f-6a8ea33f3ae3}
\end{figure}
\egroup

\begin{table}[!htbp]
\caption{\boldmath {Criteria to Evaluate the Appropriateness of Prophylaxis} }
\label{tw-01e1beec7d74}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.44160000000000004\linewidth-2\tabcolsep}p{\dimexpr.55839999999999996\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cAlignHack Criteria & \cAlignHack Explanation\\
\tblmidrule 
\cAlignHack Not prescribed, but given &
  \cAlignHack Although it was not prescribed, prophylaxis was given.*\\
\cAlignHack Although prescribed, it was not used. &
  \cAlignHack Prophylaxis was not administered although prescribed *\\
\cAlignHack prescribed and administered &
  \cAlignHack Prophylaxis was administered since prescribed \\
\cAlignHack Inappropriate antibiotic prescription &
  \cAlignHack Ineffective, harmful, or spectrum-limiting antibiotic*\\
\cAlignHack Inappropriate dosage &
  \cAlignHack Inappropriate daily dosage*\\
\cAlignHack Prolonged use &
  \cAlignHack Inappropriate length of use after the end of surgery*\\
\cAlignHack Appropriate antibiotic, dose, and duration &
  \cAlignHack Appropriate for choice, dose, and duration**\\
\cAlignHack Not prescribed and not administered &
  \cAlignHack Prophylaxis was not given since it was not prescribed**.\\
\cAlignHack Total compliance** &
  \cAlignHack "Indicated and administered with proper dose, duration, and choice" + "not indicated and not administered"\\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{*Inappropriate usage; **Appropriate usage \unskip~\cite{1443641:25188305}}
\end{tablenotes}
\end{threeparttable}

\end{table}
Distribution of subjects according to the combination of antibiotics usage (preoperative); distribution of subjects according to single antibiotic usage; routes of administration and doses of cefotaxime post-operatively were represented in Figure~\ref{f-794921c6cae4}, Figure~\ref{f-850ff708ee67} and Figure~\ref{f-9ed882a5325a} respectively. Distribution of subjects according to a combination of antibiotics usage (postoperative), Duration of antibiotic prophylaxis, Duration of antibiotics prophylaxis administration postoperatively in days were represented in Figure~\ref{f-88b0bd676804}, Figure~\ref{f-3c3f32c3c464} and Figure~\ref{f-814ea3e43711} respectively.

Criteria to evaluate the appropriateness of prophylaxis were given in Table~\ref{tw-01e1beec7d74}. Adherence of prophylactic antibiotics to guidelines; Appropriate dose of antibiotic given peri-operatively were represented in Figure~\ref{f-9614e6c95704}  and Figure~\ref{f-6a8ea33f3ae3} respectively.
    
\section{\textbf{DISCUSSION}}
This study was undertaken at Malla Reddy College \& Hospital (MRH) which is surrounded by villages comprising of the population belonging to lower socioeconomic background, unaware of proper hygienic conditions and proper antimicrobial therapy. The purpose of our study is to investigate the adherence of antibiotic prophylaxis to the national guidelines of a study conducted by Yasser Younis A, on 174 participants. Cephazolin (1 g) was shown to be the most regularly given antibiotic. In this study, it was prescribed preoperatively in 88.1 percent (104) of the samples and postoperatively in 69.5 percent (41) of the cases \unskip~\cite{1443641:25188306}. In our study, 102 samples were included, with Ceftriaxone (1g) being the most commonly prescribed antibiotic preoperatively in 42 percent (40) of the cases and postoperatively in 51 percent (42). 

A previous study by Ai-Ling Oh had shown the overall guidance rate to their national Guidelines (Malaysia) were more than 70\% \unskip~\cite{1443641:25188309}. In our study, we have found that there was 72.6\% of adherence to national guidelines (ICMR/AIIMS guidelines). This study involved 102 subjects and included 57\% females and 43 \% males. The general surgery department (57\%) contributed to most of the cases in our study. The most common surgeries performed were Hernia repair (12.7\%) and Septoplasty (12.7\%). Our study had shown that the Piperacillin-Tazobactum combination was the preferred antibiotic and had an adherence rate of 91.2\%. In the case of the combination of antibiotic usage, it had been found that Ceftriaxone+Metronidazole and Cefotaxime+Metronidazole was the most commonly prescribed combination and was seen in 23\% of subjects and 35\% of subjects preoperatively and postoperatively respectively.1gm of IV Cefotaxime was the most commonly prescribed dose in 42\% of the participants pre-operatively and 51\% of the participants post-operatively. Overall compliance to the dose following the national guidelines was found to be adherent in 91\% of the subjects. Prophylactic antibiotics were often used post-operatively in our research. In 92 percent of the cases, they were administered in several doses that lasted longer than 24 hours. Cefotaxime is a third-generation cephalosporin with broad antibacterial action against Gram-positive and Gram-negative bacteria. In our study, it had been prescribed in procedures such as Appendectomy(9.8\%), Hysterectomy (5.8\%), Excision (7.8\%), Thyroidectomy(5.8\%), Angioplasty(0.9\%), Hernia repair(12.7\%) etc. In our study, we found that there was a wide discrepancy between the drug Cefotaxime usage and the recommendations offered by the national guidelines regarding surgical antibiotic prophylaxis. In about 42\% of the total surgeries that were studied. Antibiotic prophylaxis was administered preoperatively when Cefotaxime was "not recommended. `But high-quality study titled Cefotaxime in the treatment of surgical prophylaxis by D.H.Whittman \unskip~\cite{1443641:25188299}  suggested that Surgical prophylaxis with single-dose Cefotaxime is as effective as many other agents and is simple, and has a relatively broad spectrum of activity compared to many other antimicrobials used for prophylaxis. H.Sader et al. found that single-dose cefotaxime was indicated for hysterectomies, caesarean sections, upper gastrointestinal cases, bone and joint operations, biliary tract procedures, transurethral resections, open urologic surgeries, and some vascular procedures in their study titled Cefotaxime is extensively used for surgical prophylaxis \unskip~\cite{1443641:25188298}. None of the recommendations support the use of preventive antibiotics indefinitely. Because the majority of the research indicating short-term antimicrobial prophylaxis comes from industrialised nations, prolonged usage of antimicrobial prophylaxis was widespread in our analysis. In a developing nation like India, where health-care resources are scarce and the patient's economic condition is poor, healthcare personnel, including surgeons, do not want to risk infection. However, it is possible that extended antibiotic therapy is not justified. Regimens selected are against the standard guidelines and these regimens don't cover either the standard or the alternate regimens. The reason may be due to the Selection of the best regimen which had been proved to be much efficacious in the previously admitted patients, physician's expertise and other factors such as antibiotic resistance may also contribute to its usage.
    
\section{CONCLUSION }
Overall compliance of prophylactic antibiotics was by the guidelines except for cefotaxime which was excessively prescribed. In procedures such as Excision(7.8\%), Thyroidectomy(5.8\%), Angioplasty(0.9\%), Hernia repair(12.7\%) despite using Cefotaxime third-generation cephalosporin, Cefazolin which is a first generation cephalosporin can be used. To prevent the emergence of multi-resistant organisms such as MRSA, there is a need to shift away from the traditional practise of surgeons using prophylactic antibiotics for long periods of time in the hopes of avoiding future infection. This includes adequate measures such as the development of local guidelines, SSI surveillance, educational interventions, good surgical technique, and strict asepsis in the operating room. The establishment of an institutional antibiotic guideline might be more beneficial, with a higher chance of adoption and agreement. Antibiotic availability and knowledge, as well as recommendations, were key interventions for proper surgical antimicrobial use. The healthcare administration and other interested agencies can work together to increase antibiotic availability and guarantee that they are used properly. A quality improvement programme can be aided by the active participation and provision of cooperating multidisciplinary teams, which include clinical pharmacists, dispensing pharmacists, and management. Continuous Pharmaceutical Research can be organized to update the medical fraternity according to continuously modifying drugs.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of Interest}

The authors declare that there is no conflict of interest.
    
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