Looming Antimicrobial Resistance Crisis: The Paradox of Non-Adherence to Cesarean Antibiotic Prophylaxis Guidelines in Ethiopia – A Commentary
Year: 2026
Type: article
Abstract: ABSTRACTThe administration of prophylactic antibiotics is a cornerstone of infection prevention for Cesarean section (CS), with global and Ethiopian national guidelines recommending a single, pre-operative dose of narrower spectrum ‘Access’ antibiotics like cefazolin. However, an "implementation gap" exists in Ethiopia, characterized by a shift to multiple postoperative doses and/or use of ceftriaxone (‘Watch’ group antibiotics). This shift is driven by multifaceted factors including surgical teams’ fear of contamination, supply chain fragility causing inconsistent cefazolin availability, and hierarchical ‘prescribing etiquette’ (seniority-driven prescribing culture) where junior clinicians follow legacy practices than evidence-based medicine. Paradoxically, despite this antibiotic overuse, surgical site infection rates in Ethiopia remain high (9–16%). Moreover, overreliance on multiple-dose and/or broad-spectrum agents is potentially contributing to accelerating regional antimicrobial resistance, where multidrug-resistant Gram-negative bacilli reported at rates as high as 82.7% in some Ethiopian hospitals. Global projections warn that by 2050 AMR could cause 10 million deaths annually, surpassing cancer mortality and exceeding the combined toll of malaria and tuberculosis. To address this crisis, physicians must move beyond individual prescribing habits toward systemic antimicrobial stewardship and align with WHO’s call for evidence-based surgical bundles. WHO surgical bundles, particularly underused practices such as preoperative vaginal cleansing in cesarean sections, are proven to reduce postoperative infections. Simultaneously, the Ministry of Health must prioritize the reliable procurement of 'Access' category antibiotics, such as cefazolin, strengthen adherence monitoring for national clinical guidelines, and support context-specific implementation research to build provider trust in standardized protocols.KEYWORDS: Antimicrobial stewardship, Cesarean section, Guideline Adherence, Surgical antibiotic prophylaxis, Ethiopia, Ceftriaxone, Surgical site infection.(The Ethiopian Journal of Reproductive Health; 2026; 18; 85-89)
Institution: Hawassa University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
Funder: Bundesministerium für Gesundheit
OpenAlex ID: W7225014501