Antibiotic Stewardship Practices, Prescribing Patterns and Clinician Perspectives among Plastic Surgeons in Lahore, Pakistan: A Cross-Sectional Study

Abstract

Antibiotic overprescription in plastic surgery contributes to antimicrobial resistance, yet evidence-practice gaps regarding perioperative antibiotic prophylaxis in low-and middle-income countries remain poorly characterised. To estimate compliance with evidence-based prophylaxis, characterise current prescribing patterns, examine clinician attitudes toward antimicrobial stewardship, and identify barriers to guideline implementation among plastic surgeons in Lahore, Pakistan. A cross-sectional questionnaire was administered to 41 of 69 active plastic surgery specialists in urban Lahore. The questionnaire evaluated antibiotic agent selection, vignette-based knowledge, perceived barriers, and stewardship attitudes across eight common procedures. Chi-square, one-way ANOVA, Spearman correlation, and multivariate logistic regression were conducted using SPSS version 26.0. The most used agent in all the procedures (68–82%) was Cephalosporins, which aligned with evidence based recommendations. The most frequent procedures (6 of 8) had antibiotic courses of 5 days or more. The best independent predictor of the knowledge of adequate stewardship was guideline awareness (OR = 1.69, p = 0.023) and agreeing with the 60-minute pre-incision window (OR = 1.82, p = 0.035). There was a significant positive correlation between the scores of knowledge and adherence (rho = 0.346, p = 0.026). Time limitations (65%), lack of institutional policy (50%) and pharmaceutical influences (50%) were the greatest obstacles. The major evidence-practice gap is excessive antibiotic duration (≥5 days in most procedures). Prioritising cefazolin over quinolones and implementing urgent institutional stewardship programmes are needed.