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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 patients 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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5(1), 121-134
No Researcher Research Title Design Research Subjects Research result
Study
1 Twilight Firda Usage Evaluation method Sample determined The results showed the use of
Malelaningsih, Prophylactic Antibiotics descriptive, data by the Slovin formula prophylactic antibiotics in patients
Andriyani Rahmah In Section Patients taken by of 379 patient populations aged 20-35 (76.41%) and
Fahriati, Dimas Agung Caesarea At Home retrospective who delivered vaginally > 35 years (23.59%). The antibiotic
Waskito Wijanarko, Tangerang Private Hospital SC, taken as much used is cefazoline injection
Endri Supiyati ( South 195 patients. (82.05%) and Ceftriaxone injection
Proceedings of Senantias, (17.95%). The conclusion of 160 cases
2020) of the use of prophylactic antibiotics
was in accordance with the Hospital
Formulary of 82.05% and 17.95%
which did not comply with the
Hospital Formulary.
2 Rika Yulia, Fauna Usage Evaluation studiescohort data retrieval The results obtained from this study
Herawati, Abdul K. Antibiotics and Profiles prospective there are a total of 204 indicate that the use of antibiotics
Jaelani, Wirda Germs in Section through cesarean section patient in cesarean section patients is
Anggraini (Journal Cesarean data search but only 100 ampicillin/sulbactam 37%,
Clinical Pharmacy at the District medical record eligible patients cefuroxime 34%, ceftriaxone
Indonesia, 2018) General Hospital patient inclusion criteria. 24%, 5% cefazolin, 1% metronidazole,
Pasuruan A total of 104 patients and 1% gentamicin. Compatibility based
did not meet the on the type of antibiotic
inclusion criteria respectively 5% based on PPAB,
100% based on
RS Formulary and 63% based on
Fornas. This is due to the
decreasing sensitivity pattern of
cefazolin based on the germ map
from January to March 2017.
Compliance based on antibiotic
dosage 100% according to PPAB, RS
Formulary
 and Fornas. Conformity based on
antibiotic dose and time of administration
92% matched
based on PPAB. The germ found
in the patient's wound is Hafnia
alvei bacteria.
3 Sherley Widya Usage Review method Patient population that The results of a study on cesarean section
Chandra, Samuel Budi Prophylactic Antibiotics descriptive, data had a cesarean section patients at Ibu Fatmawati Soekarno General
Harsono, Avianti Eka In Patients taken by Year 2020 as much Hospital in 2020 showed that antibiotics
Goddess Aditya Cesarean section at Mother retrospective 412 patients. Determination were the most common
Purwaningsih, (Journal Fatmawati Hospital number of samples used were cefuroxime (92.61%),
Pharmacopeia, 2020) Sukarno using a formula ceftriaxone (2.96%), ampicillin +
Surakarta City Year slovin with levels sulbactam (2.46%), ampicillin
2020 error 5% (1.48%), cefadroxil (0.49%). The
results obtained study of the use of prophylactic
a total of 203 patients antibiotics based on Gyssens
obtained categories
0 (74.06%), category VI (23.68%), and
category IVA (2.26%). The intravenous
route of administration is appropriate

guideline (100%). Dosage, interval,

duration of antibiotics are appropriate,
namely using a dose of 1-2 g with
frequency
2x a day, duration 1-2 days (100%).
Administration time ≤30 minutes (100%)
4 Syufin Nur Aini (2021) Effectiveness of Use method The sample is 78 The results of this study prophylactic
Prophylactic Antibiotics descriptive, data that fulfills antibiotics in cesarean section patients
In Surgical Patients taken by inclusion criteria used were a single type of antibiotic,
Fault at RSI Siti Aisyah retrospective namely cefoperazon (43.59%),
Madiun 2021 ceftriaxone (10.26%), and
 cefotaxime (3.84%), and combination
antibiotics namely Amoxicillin +
Gentamicin (25.64%) and Ampicillin
+ Sulbactam (16.67%). The
effectiveness of the use of prophylactic
antibiotics is seen from the absence of
purulent (pus) and no occurrence
temperature rise in patients after
cesarean section is 100% effective

5 Nurisma Tria Effectiveness Analysis design Number of samples The results showed that Cefazoline
Harwiyanti, Danang Cefazolin and study a total of 214 patients and Ceftriaxone had the same
Prawira Nugraha, Ana Ceftriaxone as cross-sectional. cesarean section with effectiveness as prophylactic
Amalia Prophylactic Antibiotics Data retrieval prophylactic antibiotics antibiotics
Cesarean section at RSIA study Cefazolin and caesarean section at RSIA Trisna
Trisna Medika done in Ceftriaxone (1:1). Medika Tulungagung October -
Tulungagung record room Measurement December 2021 based on frequency
Period medical therapeutic effectiveness pulse, respiratory rate, surgical
October–December RSIA Trisna done through: (1) wound pain 10 d post-op, pus, dry
2021 Medic condition wounds, ILO, and LOS.
Regency Clinical (temperature,
Tulungagung pulse, respiratory rate)
in brackets which was measured before
3 months time operation, 24 hours
ie on postoperatively, and during
OctoberDecember visit on the 10th
2021. postoperative day; (2)
surgical wound pain
observed 24 hours
postoperative and
during
 visit on the day
the 10th postoperative; (3) the
condition of the surgical wound
(pus and dry
wounds).
observed during the visit
on the 10th day
postoperative; (4) ILO
diagnostic results by
doctor; and (5) Length
of Stay (LOS)
calculated from
end of operation
up to the patient
home hospital.
6 Sikni Retno effectiveness descriptive and The population in this Research result
Karminingtyas, Dian Use of Antibiotics data obtained study were all cesarean showed that of the 87 patients
Oktianti, Nova Hasani prophylaxis from record section patients at the studied, most cases occurred at the
Furdiyanti (Scholar In Surgical Patients medically hospital age of 20-35 years
Journal of Pharmacy, Fault (Sectio Caesarea) retrospective Islamic Sultan Agung (75.86%), length of stay 5 days (67.82%), and
2018) Semarang in 2016 the condition of being discharged from the
that is as many as 640. hospital with status
repair (100%). The prophylactic
antibiotics used were
Cefotaxime (66.67%),
Cefuroxime (32.18%), and Cefazolin
(1.15%). The effectiveness of the use of
prophylactic antibiotics in
Sultan Agung Islamic Hospital
Semarang in 2016 which is 100%
effective. Cost average
direct medical treatment
 class I Rp.10,425,014.00, class
II Rp.
8,806,403.00 and class III of
Rp. 8,733,429.00. Based on
usage research
prophylactic antibiotics in cesarean
section patients at the Sultan Agung
Islamic Hospital in Semarang
2016 is 100% effective. The
average direct medical costs for
class I, II and treatment
III different.

7 Randy Tampai, Nancy Usage Evaluation descriptive and all patients who results of a study on the use of
Ngala, Diah Wua, Prophylactic Antibiotics data obtained take action prophylactic antibiotics in 58
(Journal In Surgical Patients from record cesarean section and patients
FARMASINDO, 2020) Fault In Installation medically using antibiotics who underwent cesarean section
Home Central Surgery retrospective prophylaxis at the Central were used
Xy Manado Hospital Surgical Installation of XY ceftriaxone (1st generation
Manado Hospital in 2019 cephalosporin)
a total of 58 patients 55 patients (94.8%) and
Cefazolin
(first generation cephalosporin) in 3
patients
(5.2%).
8 Devi Ristian Octavia( Evaluation of The Use descriptive And Subject The results of the study of 54 patient
Indonesian Journal of Prophylactic Antibiotics data obtained study were all cesarean medical records
Health Research, 2019) in Caesarean Surgery from record section patients in the cesarean section, indicating that
Patients medical in a manner period the prophylactic antibiotics used
retrospective August-September were
2018 that fulfills 98.1% use class
Penicillin (Amoxicillin), And
 inclusion criteria viz
as many as 54 patients
the rest
using a third generation
cephalosporin (Ceftriaxon 1.98%).
Dose
used a single dose and the time
of administration is intravenous

given 30 minutes before incision or after

clamping the umbilical cord
9 Yessy Mia Wardhani, Evaluation Use descriptive And Data the results of the study found that
(Journal Health Antibiotics prophylaxis data obtained Which used on the antibiotics that are widely used
Saelmakers In Patients Surgery from record sample study This are antibiotics
PRIME, 2021) Fault (Section medical in a manner as much 148 patients The third generation cephalosporin,
Caesarea) In House retrospective in the period April – namely Cefoperazone, is given
Sick Siloam May intravenously. suitability
Palembang. 2020 and the data is Antibiotic use in Caesarean
obtained from part section patients compared to the
medical record House Formulary
Sick Siloam The hospital is in accordance with
Palembang POGI (Association Obstetrics
Indonesian Gynecology),
ASHP Therapeutic guidelines,
the right indication is obtained, the right patient
is right, the right drug is obtained
and right dose
10 Chusun, Maya Pattern Prescription descriptive And House Sick on The results showed that of the 300
Kurniasari (Journal Prophylactic Antibiotics data obtained period 1 patients who had parturition, there
Research pharmaceutical Pre Surgery Sectio from record January–June 30 2019 were normal parturition in 52 patients
Indonesia, 2021) Caesarea Di House medical in a manner samples were obtained (17.3%) and parturition withSectio
Bro retrospective as many as 300 patients, Caesareaas much
South Jakarta namely, postpartum patients 248 patients (82.7%). Most ages
normal and parturition are between 20-30 years
 surgicallySectio 123 patients
Caesareaas many as according to (49.6%) and aged between >30-40
the inclusion criteria years in 120 patients (48.38). As for
248 patients parturition the statuses
surgicallySectio the most payment was in cash,
Caesarea. namely 176 patients (71%). The class
of antibiotics
The most frequently used was the
cephalosporin class, namely 246
patients (99.6%), type
The most used antibiotic was
Ceftriaxone in 175 patients
(70.6%).
Research on Surgical Wound
Infection (ILO) found only in 1
patient (0.4%)
with the antibiotic Ceftriaxone.
11 Wulan Anggraini. Description descriptive And Sample is mother The results showed that all birth
Yulia Herliani, Etin Wound healing data obtained giving birth by sectio mothers (100%) were given
Rohmatin, (Journal Post Operations from record caesarea at SMC Hospital, antibiotics
Bidkesmas, 2019) Sectio Caesarea medical in a manner Tasikmalaya Regency ceftizoxime as a single dose in
With Giving retrospective on month preoperative sectio caesarea
Antibiotics October-November mothers. Healing
Ceftizoxime As year 2018 Most of the preoperative sectio caesarea
Dosage prophylaxis as many as 53 people maternal surgical wounds on the third day
Single obtained with were included
In the hospital purposive technique cured category (83%).
Singaparna Medika sampling.
Citrautama
Tasikmalaya Regency
year 2018
12 Rahayu Septia swing, Evaluation Of The Use descriptive And
Ade Maria ULFA, Prophylactic Antibiotics data obtained
women Primadiamanti In Cesarean Section from record
( Journal Knowledge Patients In The Central medical in a manner

Health Interests, Surgical Installation retrospective

2022)
13 Ninik Mas Ulfa, Selly Analysis effectiveness descriptive And The sample size is 39 SC
Septi Fandinata, Yuni Cefazoline, data obtained patients Cefazoline prophylactic antibiotics are more
Hendrawati, (As-Syifaa ceftriaxone, from record effective in inhibiting the occurrence of
Pharmacy Journal, 2019) Cefotaxime As medical in a manner postoperative CS infections based on pre
Prophylactic Antibiotics retrospective post body temperature measurements and
In Sectio Patients pre post leukocytes of patients undergoing
Caesarea SC.
14 Nida Nurhidayah Evaluation Use descriptive And Subject study Pattern use antibiotics
sunarti, Juda Brotherhood Antibiotics data obtained
prophylaxis is all patients cesarean section prophylaxis
kusuma, (Seminar on from record surgery fault as much the most was cefazolin (94.6%). Evaluation
National Research Patient Surgery fault medical in a manner 92 of the use of prophylactic antibiotics for
and Service to (Section Caesarea) in retrospective (Sectio Caesarea) in cesarean section found that the right
Society, 2021) RSUD Prof. period patient, the right indication, the right
Dr. Margono Soekarjo January-December 2020 route of administration (100%), the right
2020 year drug (94.6%), the right dose
(94.6%), and timely administration
(83.7%). In conclusion, the use of
prophylactic antibiotics in
Caesarean section patients are said to
be rational because they comply with
the guidelines for use
prophylactic antibiotics in cesarean section
patients.
15 Rahma Hardiyanti, Studies Comparison descriptive And Number of respondents at Parameter evaluation difference
Rodiani, Evi Effectiveness of Use data obtained this study were 88 effectiveness use antibiotics
Kurniawati, Ratna Antibiotics from record patientssection preoperative and
Goddess Puspita Sari, In Patients Sectio medical in a manner cesarean Which shared postoperative namely body temperature,
(Archives Pharmacia, Caesarea at RSUD Dr. H. retrospective become 2 group. leukocyte levels and length of patient care.
2020) Abdul Moeloek Group First Intermediate analysis results
Lampung province (n=44) is the time of administration of antibiotics with the
group patient's body temperature and leukocyte levels
patient Which obtained p-value
get antibiotics of 0.016<0.05 and 0.000<0.05 and the results
cefazolin 1gr IV of the analysis between the differences in
preoperative and group administration time
second (n=44) antibiotics with the length of
is the patient group patient care obtained p-valueof
Which get 0.554> 0.05. Conclusion
antibiotics ceftriaxone there is a difference effectiveness
1gr IV and cefotaxime Preoperative and postoperative use
1gr of antibiotics
postoperative IV significantly based on the patient's
body temperature and leukocyte
levelscesarean section, but found no
significant difference based on the
length of patient care.
16 Huntari Harahap, Anati Influence Use descriptive And 318 patients The results of the study of cesarean
Purwakanthi, Erny Antibiotics prophylaxis data obtained fulfil criteria section patients at Raden Mattaher
Kusdiyah, (JMJ, 2020) With from record research inclusion Hospital Jambi in 2018, most aged 20
Length of Hospitalization in medical in a manner to 35 years, namely 240 people, 135
Patients with Caesarean Section retrospective primigravidas, 244 people with a
history of cesarean section for the
first time, used prophylactic
antibiotics for cesarean section,
namely ceftriaxon once
 two grams for 3 days, with the most
diagnosis of cesarean section due to
premature rupture of membranes as
many as 87 people. There is a
relationship between the type of
prophylactic antibiotics given (p =
0.00) and
number of administration (p=0.00) with
length of stay.
17 Frances L. Pattiasina, Effectiveness Analysis descriptive And There are 50 sample The results of this study confirmed that there
Delina Hasan, Prih Granting Fee data obtained appropriate criteria was no difference in clinical outcome (in the
Sarnianto, (Journal Cefadroxil antibiotics from record inclusion form of surgical wound infection) between
Islamic Pharm, 2021) and Cefixime On medical in a manner

Sectio Caesarea patient retrospective patients receiving cefixime and

At Tarakan Hospital cefadroxil antibiotics. Results:
Jakarta in 2018 cefadroxil has a greater value for
effectiveness
and the unit cost value is greater than
cefixime, namely the effectiveness
value is 3.76 with a unit cost value of
IDR 9,224,429 while
cefixime 3.60 with a unit cost value of
IDR 8,946,515. Conclusion: Antibiotics
cefixime more cost-effective
compared to cefadroxil.

18 Shofiatul Fajriyah, The Use of Prophylactic descriptive And population as big 785 Research result
Umul Farida, Sri Antibiotics for data obtained patient so that obtained type antibiotics
Augustine, Lelly Cesarean Section from record obtained amount prophylaxis on patient who
Winduhani Astuti, Esti Delivery and the medical in a manner minimum sample underwent a cesarean section
Ambar Widyaningrum, Incident of Surgical Site retrospective studied were 98 patients.
( Infection Sampling technique
 Indonesian Journal of used is namely ceftriaxone 2 gr (99%) and
Pharmaceuticals purposive cefotaxime 2 gr (1%) with intervals of
Education, 2023) sampling. antibiotic administration
prophylaxis 30 to 60 minutes
before surgery. Patients who
experience events
ILO as many as 3 patients (3%) on
days 7-10.

19 Clara Octavianty, Rika Profile Use descriptive And Subject study The results obtained from this study
Yulia, Fauna Herawati, Antibiotics data obtained
prophylaxis is surgical patient are that the quantity of antibiotic
Heru Wijono, (Journal in Surgical Patients in from record period January-June use for the January-June 2019 period
Undip, 2021) One medical in a manner 2019 is dominated by the antibiotic
Private Hospital City retrospective that meet the criteria ceftriaxone (J01DD04) with a total
Surabaya inclusion that is as much value of DDD/100patient-dayson
241 research sample, preoperative
Then counted with namely 17.95, on operation 23.57, and
use post operation 23.22.
method DDD/100
patient-days.

20 Widia Novietaningtyas, Evaluation Of descriptive And The number of patients 95 patients The research results show the
Selpina Kurniasih, Prophylactic Antibiotics data obtained pattern of use
Nuriyatu, Fatonah. Drug Use In Caesarean from record prophylactic antibiotic drugs in cesarean
Patients (Sectio medical in a manner section patients, namely single therapy
Caesarea) HOSPITAL retrospective with cefotaxime (97.89%) and single
Regency Tangerang therapy with ceftriaxone (2.11%).
In 2018 Evaluation of the use of prophylactic
antibiotics in patients with caesarean
section, namely the right drug (100%),
the right dose (100%) and the right time
of administration (3.16%).
21 Rangti women Evaluation Use descriptive And Of the 247 patients whoThe results showed that the old
Harartasyahrani , Antibiotics prophylaxis data obtained underwent surgery discrepancy gift
Sarmalina Simamora, On from record surgery at "X" still relatively lower
(Muara Science Journal, Surgery Patient Category medical in a manner Hospital
Prabumulih City than research previously.
2021) Highly Recommended retrospective on January- Possibility he gave
At "X" Hospital, December long term antibiotics
Prabumulih City 2019, there is 131 exists
patient which include concern over possible infection,
surgical procedure with as well
category highly based on the factors present Which
in
recommended, the patient, so antibiotics are
and from 77 collected given for a longer time as a form
medical record data, of maintenance.
76 records
fulfilling medical
There were 119 inclusion
criteria use
antibiotics prophylaxis
Which furthermore
used in
processing and analysis of
data.