A Comprehensive Evaluation of Antibiotic Use Appropriateness in General Surgical Ward and Its Associated Factors

Samirah (Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia)
Firstia Rif’atul Chumaidah (Master Program of Clinical Pharmacy, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia)
Amaliyah Rusmanto Zubaidi (Master Program of Clinical Pharmacy, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia)
Bambang Arianto (Department of General Surgery, Hajj General Hospital of East Java Province, Surabaya, Indonesia)
Dewi Ramdani (Department of Pharmacy, Hajj General Hospital of East Java Province, Surabaya, Indonesia)

JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA
Vol. 13 No. 2 (2026): JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA

Background: Antibiotic use in general surgical wards is essential for preventing surgical site infections (SSI), although irrational prescribing remains common and increases the risk of antimicrobial resistance. Objective: This study aimed to examine antibiotic use patterns, assess the appropriateness of antibiotic use, and analyze factors associated with antibiotic use in a surgical ward. Methods: A cross-sectional study was conducted using medical records from the general surgical ward of Hajj Regional General Hospital, East Java, Indonesia, from May to June 2023. Antibiotic use patterns were measured using the ATC/DDD methodology and the WHO AWaRe classification. The appropriateness of antibiotic use was assessed using the Gyssens classification. Descriptive analysis was used to characterize the demographic profiles, bacterial isolates, and antibiotic use. The chi-square test was used to assess the association between patient characteristics and the appropriateness of antibiotic use. Results: A total of 180 patients participated in this study, most of whom were female (56.67%) and aged 46-59 years (34.44%). The results indicated that the most commonly isolated bacteria were ESBL-producing Escherichia coli (14.29%) and Staphylococcus aureus (14.29% each). Cefazolin was the predominant prophylactic agent, accounting for 87.34% of the total, with a DDD per 100 procedures value of 32.85. In comparison, ceftriaxone and metronidazole were the most prescribed therapeutic antibiotics, accounting for 39.94% and 27.93% of the DDD values of 36.50 and 26.19 per 100 patient-days, respectively. Antibiotics classified in the Watch group predominated among therapeutic prescriptions (56.33%), whereas the Access group accounted for only 42.87%. The appropriateness of antibiotic use was documented in 68.89% of the cases, with the most common causes of inappropriate antibiotic use being inappropriate timing (9.84%) and duration (9.21%). Age, diabetes comorbidity, and LOS were significantly associated with the appropriateness of antibiotic use. Conclusion: Although the appropriateness of antibiotic use in the general surgical ward was relatively high, substantial improvements are recommended through monitoring and strengthening adherence to clinical guidelines.