Use of the PCNE classification to analyze DRPs associated with the use of antibiotics in caesarean sections

Resumen

Background: The Ecuadorian Clinical Practice Guideline for Cae- sarean Delivery Assistance addresses preoperative antibiotic prophylaxis (PAP), but it does not establish specific protocols for antibiotics use. This leads to a great variability since each physician uses different therapeutic schemes according to his own individual judgment. Purpose: The aim of this study is to identify and categorise the DRPs associated with the use of antibiotics in women undergoing cesarean delivery in a secondary-care hospital and to analyse the causes of these problems. Method: Observational, retrospective, descriptive study. 814 women undergoing cesarean delivery at the Ambato General Hospital of Ecuador during 2018 were included. Patients with premature preterm rupture of membranes far from term or antibiotic treatment for active infections, and those with incomplete clinical history were excluded. Different variables related to the patient, the surgery and the antibiotic treatment were collected from the hospital medical records. A clinical pharmacist reviewed the treatments and assessed compliance with international guidelines for PAP use. DRP analysis and characteri- zation was conducted using the Pharmaceutical Care Network Europe (PCNE) Classification V9.1 and considering the following variables: drug selection, dose, treatment duration, prescribing process and drug use process. Findings: Patients were aged between 16 and 48 years (30.87 ± 5.50). DRPs were detected in all women (1125, 1.38 DRPs/patient), the most frequent ones associated to failure to administer PAP despite being indicated (30.10% of patients, subdo- main P1.3 ‘‘Untreated symptoms or indication’’) and to unnecessary postsurgical antibiotic treatment continuation (100% of patients, subdomain P3.1 ‘‘Unnecessary drug-treatment’’). Of the 1935 possi- ble causes for DRPs identified, most of them were related to inappropriate drug selection. Although the recommendation is to use first generation cephalosporins (cefazolin) or, in patients allergic to beta-lactams, to administer a joint treatment of gentamicin and clin- damycin, 13 different antibiotics were used. Cefazolin was administered as prophylaxis in 98.07% of the PAPs, as well as a postsurgical treatment to the 79.36% of the total number of patients. Cefalexin was always administered postoperatively (in 71.45% of the cases). The duration of the postoperative treatment was 7 days. Conclusion: The high number of DRPs found (1.38 DPRs/patient) suggests the need to stablish protocols for antibiotic usage in the institution. The PCNE V 9.1 Classification made it possible to cate- gorize DRPs and their causes, thus facilitating the reporting of results to the professionals involved.