Assessment of Antibiotic Consumption Patterns in Obstetric Inpatient Care: A Narrative Review
Author
Syeda Zohra Batool, Bilal K V, Ashwini Bhide M A, Shubhashree M S, Vybhav U, Umesh M, Hanumanthachar Joshi
Abstract
Background: Antimicrobial consumption surveillance in hospitals commonly uses defined daily doses (DDDs) per 100 bed-days. Although useful for general inpatient surveillance, this measure may be poorly aligned with obstetric care, where antibiotic exposure is frequently concentrated around delivery, prophylaxis may consist of a single administration, hospital stays are short and physiologically determined, and pregnancy produces pharmacokinetic changes that may separate prescribed doses from adult DDD values.
Objective: To assess how antibiotic consumption has been measured in obstetric inpatient care, examine the assumptions and limitations of DDD per 100 bed-days, consider lessons from paediatric and neonatal surveillance, and evaluate a delivery-anchored framework for reporting childbirth-associated antibiotic consumption.
Methods: A narrative review was conducted using purposive searches of PubMed, Scopus and Google Scholar, supplemented by citation tracking. Literature relevant to antimicrobial-consumption measurement in obstetric and peripartum care, and methodological studies from paediatric and neonatal settings, was synthesized thematically. PRISMA 2020-informed reporting principles were used to present the literature identification and selection process transparently; the review was not conducted as a systematic review and no meta-analysis was performed.
Results: Published obstetric studies used heterogeneous measures and denominators, including prescriptions, patients, deliveries, procedures, bed-days and proportions exposed. Three recurring measurement concerns were identified: single-dose prophylaxis is represented within the DDD numerator without conveying dose timing or duration; the bed-day denominator is sensitive to short and variable length of stay; and adult DDD constructs may not fully reflect dosing and pharmacokinetic characteristics of pregnancy. Paediatric and neonatal literature demonstrates that alternative measures, including days of therapy and population-specific DDD approaches, are feasible. A delivery-anchored framework using DDD per 100 deliveries, doses per delivery and days of therapy per 100 deliveries is proposed.
Conclusion: Assessment of antibiotic consumption in obstetric care would benefit from reporting that reflects the delivery episode as well as antibiotic amount and duration. DDD per 100 deliveries may be a useful candidate measure for childbirth-associated exposure, but it should initially complement rather than replace DDD per 100 bed-days. Multicentre validation, stratification by mode of delivery and separation of prophylaxis from treatment are needed before routine adoption.
Keywords
antibiotic consumption; obstetric care; antimicrobial stewardship; defined daily dose; days of therapy; caesarean section
Full Text:
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