SYSTEMATIC REVIEW: EVALUATION OF THE USE OF PROPHILACIC ANTIBIOTICS

IN CAESAREA SECTION PATIENTS

dr. I Nyoman Triaditya Kresna Putra/ 71225050/ 10B
Marine Lieutenant Colonel (K) Dr. drg. Arif Rachman,SH.,MH.,MM., MTr.Hanla.,Sp.Pros., CIQnR., CIQaR
Adhirajasa Reswara Sanjaya University

INTRODUCTION
Every medical action always has the potential to pose a risk, both for patients, health
workers and hospitals. The potential for unwanted events is relatively higher in invasive
medical procedures, including surgery. One of the undesirable events in surgery is the
occurrence of surgical wound infection.
Surgical wound infection is an important issue in the world of public health. Based on
data owned by WHO, until now there is no known incidence of surgical wound infections
globally. Surgical wound infections occupy the second or third position of nosocomial infections
in developed countries. The incidence of surgical wound infections in developing countries is
higher than in developed countries, in Southeast Asia the incidence of surgical wound infections
is 7.8%. In Indonesia alone, the incidence of surgical wound infections ranges from 3–18%.
There are many factors that influence the emergence of surgical wound infections, one of which
is the type of surgery. Gastrointestinal surgery is proven to be 4.46 times more likely to
experience a surgical wound infection compared to other surgical procedures.
Prophylactic use of antibiotics intraoperatively can reduce ILO appropriately.
Prophylactic antibiotics are given to patients with the aim of reducing the number of bacteria
present and helping the natural defenses of the host so that infection can be prevented. 7
Adequate use of perioperative prophylactic antibiotics can reduce the incidence of ILO by up to
50%. 8 In addition, the use of appropriate antibiotics can help reduce the incidence of antibiotic
resistance.
 The purpose of this study was to determine the pattern of use of prophylactic antibiotics in patients undergoing sectio caesarea surgery.

METHOD
The research method used is Systematic Literature Review. Literature review on pattern of use of prophylactic antibiotics in pati ents
with sectio caesarea. Literature was obtained from 3 academic databases, namely: Google Scholar, ProQuest, and Pubmed. The minimum
number of articles planned is 10 articles, which were published in the last 5 years. The initial articles obtained from the academic database were
38 articles which were then screened to obtain appropriate articles and presented in the form of a PRISMA flow diagram so that 21 articles were
suitable for use.

DISCUSSION
Based on all the results of the reviews that have been carried out on 21 articles, it was found that all mothers who were going to have a
sectio caesarean operation (100%) were given antibiotics. Even though the use of prophylactic antibiotics was said to have been carried out
100%, in one study (Firdha SM, 2020), out of 160 cases the use of prophylactic antibiotics was said to be in accordance with the Hospital
Formulary of 82.05% and 17.95% which did not comply with the Formulary Hospital. In theory, giving antibiotics as post-operative prevention
is proven by research (Rahma H., et all, 2020) where testing was carried out to test the effectiveness of the use of preoperative and postoperative
antibiotics which were meaningful based on the patient's body temperature and leukocyte levelscesarean sectiongot p-valueof 0.016 <0.05 and
0.000 <0.05, which means that giving antibiotics both preoperatively and postoperatively significantly reduced the ILO rate after sectio caesaria
surgery.

Based on the type of antibiotics given, from 6 studies the most frequently used were the cephalosporins, namely ceftriaxone, cefotaxime,
cefazolin. As in a study made by (Randy T., 2020) showed that the use of prophylactic antibiotics in 58 patients undergoing cesarean sections
used the antibiotic ceftriaxone (1II generation cephalosporin) in 55 patients (94.8%) and Cefazolin (first generation cephalosporin) as many as 3
patients (5.2%). These results are in accordance with research (Chusun, 2021) based on the class of antibiotics most often used, namely the
Cephalosporin group, namely 246 patients (99.6%), the type of antibiotic used the most used was Ceftriaxone in 175 patients (70.6%). However,
in the use of ceftriaxone antibiotics, 1 patient (0.4%) had ILO (Surgery Wound Infection).
Based on the effectiveness of giving prophylactic antibiotics, it is said that Cefazoline is more effective in inhibiting the occurrence of
post-operative SC infections based on measurements of pre-post body temperature and pre-post leukocytes in patients undergoing CS (Ninik
MU, et all, 2019). However, based on cost-effectiveness, cefixime antibiotics are more cost-effective compared to other antibiotics.

CONCLUSION
From the results of a literature review of 21 articles, it was found that all mothers who were going to have a sectio caesarean operation
(100%) were given antibiotics even though as many as 17.95% did not comply with the Hospital Formulary. The types of antibiotics that are
often used as prophylaxis are the cephalosporin group, namely ceftriaxone, cefotaxime, cefazolin, cefixime. Ceftriaxone is the first choice
antibiotic as prophylaxis for sectio caesarea surgery. Based on effectiveness, Cefazoline is more effective in inhibiting the occurrence of
postoperative sectio caesarea infections and based on cost-effectiveness, cefixime is more cost-effective compared to other antibiotics.

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