Gaps between antibiotic prescribing practices and international
guidelines for women undergoing caesarean deliveries in rural Rwanda: A
retrospective cohort study
Objective: Antibiotic stewardship remains a significant challenge in
sub-Saharan Africa, with paucity of systematic data on antimicrobial use
in surgical care. We characterise antibiotic prescribing practices for
women who delivered via caesarean section (c-section) in rural Rwanda.
Design: Nested retrospective cohort study. Setting: Kirehe District,
rural Eastern Rwanda. Population: All women aged > 18 years
who delivered by c-section between November 2017 and February 2018.
Methods: Data on antibiotic use, including name, indication,
dose/frequency/route, time, and duration of administration were
extracted from patient charts. Prescribing practices statistics were
summarised by the timing and type. Main Outcome Measures: Pre-operative
and post-operative antibiotic prescriptions, by time, name and dose.
Results: A total of 506 patients were enrolled. 80.8% received a
pre-operative antibiotic, with 67.4% receiving an antibiotic within one
hour of incision. The most prevalent pre-operative antibiotics
prescribed were Ceftriaxone (83.3%) and Ampicillin (15.0%).
Post-operatively during hospitalisation, 95.7% of patients received two
antibiotics, most commonly Ampicillin (99.2%) in combination with
Gentamicin (98.5%). For all but one, antibiotics were prescribed
without indication of infection. At discharge, while 27.8% of patients
were not prescribed any additional antibiotics, 72.2% were prescribed
at least one antibiotic. Conclusions: Large deviations in antibiotic
prescribing practices as compared to international prophylaxis
guidelines were observed. Further studies to understand the rationale
for these deviations and the effects of over-prescription on infection
prevention and antibiotic resistance are needed to support
context-appropriate guidelines in Rwanda and in comparable settings.
Funding: NIH R21EB022369 Keywords: Antimicrobial use, sub-Saharan
Africa, global surgery