Abstract
Background & Rationale: Ministry of Public Health introduced “antibiotic use in vaginal delivery of
normal term labor” as an indicator of rational drug use (RDU) service plan with target goal of not more
than 10% use. Mahasarakham Hospital implemented this RDU policy in October 2016 via meetings,
setting a goal and practice guideline together with regular monitoring and evaluation. The objective of
the present study was to examine effects of the RDU policy on antibiotic use, expenditure on antibiotic
and infection rate after implementing the policy among vaginal delivery of normal term labor in
Mahasarakham Hospital. Methodology: A retrospective study was conducted using hospital data of
vaginal delivery of normal term labor during October 2015 to April 2018. Antibiotic use and expenditure
were obtained from the 43-file standard dataset. Infection rate was collected from readmission record
of obstetrics and gynecology department. Patterns of antibiotic use after implementing the policy were
investigated from medical record reviews between October 2017 and April 2018. Mann-Whitney U test
was performed to compare antibiotic use rate and expenditure and infection rate between before (October
2015 – October 2016) and after (November 2016 – April 2018) policy implementation. Segmented
regression of interrupted time-series analysis was applied to examine policy effects. Results: Comparing
before and after policy implementation, the antibiotic use rate and expenditure were declined significantly
(median antibiotic use rate: 100% vs 13.2%, p<0.001 and median expenditure per month: 8,368
baht vs 1,328 baht, p<0.001). The infection rates were not significantly different (median: 0% vs 0%,
p=0.222). From time-series analysis, the policy significantly decreased antibiotic use rate (-82.1%, 95%CI:
-87.3 to -76.9, p<0.001) and decreased monthly-expenditure of antibiotic use (-6,663.2 baht, 95%CI:
-8,396.7 to -4,929.8, p<0.001) but no effects on infection rate by month (0.063%, 95%CI: -0.280 to 0.406,
p=0.709). From chart review of 721 vaginal normal deliveries, 45 women (6.2%) used antibiotics. The
major reason of antibiotic use was the 3rd - 4th degree tear (14 women, 31.11%). Amoxycillin and Cefazolin
were mostly used antibiotics. Conclusion: The findings of this study indicate that implementation of the
RDU policy significantly reduced antibiotic use and expenditure and did not increase infection rate. The
policy could improve rational use of antibiotic prophylaxis in vaginal delivery of normal term labor.
