Antibiotic prescription practices and cost in caesarean deliveries: a hospital-based study in Lao PDR

Caesarean delivery is one of the leading indications for antibiotic use in Lao People’s Democratic Republic (Lao PDR). National guidelines recommend a single pre-incision intravenous dose of ceftriaxone for surgical antibiotic prophylaxis (SAP), yet evidence on adherence and associated costs remains limited. This study assessed compliance with national guidelines, described prescribing patterns, and estimated the economic burden of non-adherence across three hospital levels. A retrospective descriptive study was conducted using medical records of women undergoing caesarean delivery between January and June 2024 in three hospitals representing central, provincial, and district levels. Demographic and antibiotic prescribing data were extracted. Compliance was assessed against the 2020 Lao Adult Antimicrobial Prescribing Guideline. Antibiotics were classified according to the WHO AWaRe framework, and costs were estimated using hospital acquisition prices. A total of 1,105 medical records were included, of which 1,102 women (99.7%) received antibiotics. Ceftriaxone (42.3%) and cephalexin (37.9%) were the most frequently prescribed antibiotics, and the regimen of ceftriaxone for 3 days followed by cephalexin for 5 days accounted for 70.9% of patients. Overall, Access-group antibiotics represented 57.4% of prescriptions, below the WHO target of at least 60%. Only 6.7% of prescriptions met the antibiotic selection criterion, and no case fully complied with all guideline criteria. The estimated antibiotic expenditure was US$9,122.3, compared with a guideline-based cost of US$991.8, indicating avoidable excess spending of US$8,120.5 (89.0%). Antibiotic prophylaxis for caesarean delivery in Lao PDR shows poor adherence to national guidelines, characterized by prolonged postoperative antibiotic use, suboptimal Access-group antibiotic utilization, and substantial avoidable costs. Strengthening antimicrobial stewardship and adherence monitoring, particularly at central hospitals, is needed. Further research should evaluate whether the current national recommendation of ceftriaxone remains the most appropriate strategy in the Lao context.