Clinical Profile and Antimicrobial Prescription Pattern in Patients Undergoing Cholecystectomy at a Tertiary Care Hospital

Abstract

Although guidelines advise against routine antibiotic prophylaxis in low-risk elective laparoscopic cholecystectomy, overprescribing remains common. Evidence on patient profiles and antibiotic use in Eastern Nepal is limited. This study aimed to determine the clinical profile and antibiotics prescription pattern in patients undergoing cholecystectomy. A descriptive cross-sectional study was conducted among 254 patients undergoing cholecystectomy at B.P. Koirala Institute of Health Sciences between September 2023 and June 2024. Demographic, clinical, and prescribing data were extracted from patient files and prescription cardex. Antibiotics utilization pattern was evaluated using WHO core drug use indicators. Data were analyzed using SPSS-20. Out of 254 patients, most patients were female (78.35%), with a mean age of 46.21±14.46 years. Symptomatic gallstone disease was the main indication (92.52%). A total of 748 antibiotics were prescribed, averaging 2.94±0.46 per patient. Penicillin–β-lactamase inhibitor combinations predominated (49.19%), with ampicillin/sulbactam accounting for 48.79% of all prescriptions. Only 0.67% of antibiotics were prescribed by generic name, 11.09% were from the National List of Essential Medicines, and 78.20% were fixed-dose combinations. Injectable antibiotics accounted for 69.12% of prescriptions. The mean duration of therapy was 8.18±3.15 days. Culture testing was performed in only 0.40% of cases. Antibiotic use in cholecystectomy showed excessive use of broad-spectrum fixed-dose combinations, prolonged therapy, and poor adherence to essential medicine and generic prescribing principles. Strengthening antimicrobial stewardship and implementing procedure-specific guidelines are urgently needed.