Economic Burden of Inappropriate Antibiotic Use for Prophylactic Purpose in Shiraz, Iran


N Hatam 1 , M Askarian 2 , * , AR Moravveji 1 , O Assadian 3

1 Department of Health Management, Shiraz University of Medical Sciences, Fars, Iran

2 Professor of Community Medicine, Shiraz University of Medical Sciences, PO Box: 71345-1737, [email protected], Fars, Iran

3 Department of Hygiene and Medical Microbiology, Medical University of Vienna, General Hospital Vienna, Austria

How to Cite: Hatam N, Askarian M, Moravveji A, Assadian O. Economic Burden of Inappropriate Antibiotic Use for Prophylactic Purpose in Shiraz, Iran, Iran Red Crescent Med J. Online ahead of Print ; 13(4):234-238.


Iranian Red Crescent Medical Journal: 13 (4); 234-238
Article Type: Research Article
Received: August 10, 2010
Accepted: October 18, 2010




Background: Because economic data on the prophylactic usage of antibiotic in Iran are scant, we have conducted a cross-sectional study with provider perspective to measure costs and appropriate use of antibiotics in surgical wards of 6 training hospitals affiliated to Shiraz University of Medical Sciences (SUMS), Iran.

Methods: Over a six-month period 1,000 consecutive patients undergoing surgical operation were enrolled and information on prophylactic antibiotic administration was collected. The information included basic patient's demographic data, types of surgery, category of antibiotic, dosage, dosage intervals, route of administration, number of doses, initiation times and duration of administration. In order to determine the agreement between prescribed antibiotics and medical indication, the American Society of Health-System Pharmacists (ASHP) guidelines were applied.

Results: Nine hundred and ninety three out of 1,000 patients (99.3%) had received at least one antibiotic and 908 patients (91.4 %) received antibiotics because of a medical indication. Five out of 913 patients who had indications for antibiotic prophylaxis did not receive any antibiotic. Antibiotics were prescribed for 85 out of 87 (98%) procedures in which an antibiotic was not indicated. The average cost of antibiotic prescription per surgical procedure was 786,936 Iranian Rials (corresponding to 99.60 USD or €82.90). The most frequent prescribed antibiotic was cefazoline adding 53.3% of the total cost of antibiotics. In total, 36,516,190 Iranian Rials (corresponding to 4,622.95 USD or €3,845.20) were spent for cefazoline alone.

Conclusion: The results of this study showed that all surgical patients received at least one antibiotic as prophylaxis for any infection in the surgical site. Our results indicate over- and misuse of antibiotics in Iran leading to a great amount of economic burden, since in 98% of all procedures, antibiotics were used inappropriately.


Antibiotic Prophylaxis Economic Burden Iran

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