Insights from outside BJOG

When is antibiotic cover indicated for surgical procedures and how often is it used appropriately? These are complex but important questions that are seldom confronted at personal, institutional or national levels, but an informative article on the topic from Australia has been published (Ierano et al. JAMA Netw Open 2019;2:e1915003). Gathering data from more than onefifth of the country’s hospitals, the researchers showed that 10–20% of inpatient antibiotic prescriptions were for surgical antimicrobial prophylaxis and they were able to gauge the appropriateness of the medication. Of nearly 10 000 procedural assessments, they found incorrect timing and too long a duration were the most common errors, occurring in roughly half of the cases for which they had information. National guidelines suggest some clean procedures do not require ‘cover’ and that when used, prophylaxis should be a single dose and should certainly not be extended for 24 hours or longer. It was noted that gynaecological surgeons had higher rates of incorrect use than orthopaedic surgeons (used as the reference group). This is ground-breaking work, and the authors are commended for their initiative. The stewardship of antimicrobials is essential to guard against antibiotic-resistance development. Some countries have guidelines or position statements that are specific for obstetrics and gynaecology about the type, timing and duration of antimicrobial prophylaxis. If these were promoted, they may encourage individuals to conform within our speciality and could be an incentive to others to achieve the wider goal of correct antibiotic usage for surgery.