Cost-Effective Analysis of Ceftriaxone as Prophylactic Antibiotic in Caesarean Section: Single Dose Versus Multiple Dose

  • Bayu Pertiwi Fakultas Farmasi, Universitas Pancasila
  • Hesty Utami Ramadaniati Fakultas Farmasi, Universitas Pancasila
  • Prih Sarnianto Fakultas Farmasi, Universitas Pancasila
  • Dwirani Amelia Fakultas Farmasi, Universitas Pancasila


The provision of single-dose prophylactic antibiotics within 30 to 60 minutes before caesarean has been highly recommended, yet its implementation in hospitals varies considerably. This research aimed to analyze the cost-effectiveness of prophylactic antibiotics given a single dose versus multiple doses during caesarean section surgery. A retrospective observational study with a crosssectional design involved pregnant women undergoing caesarean section and receiving a ceftriaxone single dose before surgery (Group 1) versus those receiving multiple ceftriaxone doses (Group 2). The study calculated direct medical costs (hospital perspective), with surgical site infection (SSI) as the effectiveness parameter. The chi-square test was used to compare SSI between the two groups. There were 806 patients (group 1) and A total of 250 patients (Group 2) met the inclusion criteria. Analysis of total cost revealed no significant difference between both groups (approximately IDR 13,000,000/patient), yet patients receiving prolonged Ceftriaxone were associated with significantly higher antibiotic costs (p-0.000). The study documented 1.2% SSI in Group 1 and 0.8% in Group 2 (p=0.742). Calculation of the incremental cost-effectiveness ratio found that an extra IDR 3,278,000 was needed to provide additional success to prevent SSI by administering multiple doses of ceftriaxone. In conclusion, a single dose prophylactic antibiotic provides comparable efficacy to a multiple-dose regimen, but at a lower cost.


1. Organisation for Economic Cooperation and Development (OECD). Health at Glance 2019: OECD Indicators2019 [cited 2021 20 April]. Available from:,five%20years%20(Figure%209.17).

2. Verma V, Vishwakarma RK, Nath DC, Khan HTA, Prakash R, Abid O. Prevalence and determinants of caesarean section in South and South-East Asian women. PLoS ONE. 2020;15(3):e0229906.

3. Lauer JA, Betran AP, Merialdi M, Wojdyla D. Determinants of caesarean section rates in developed countries: supply, demand and opportunities for control. World Health Report. 2010;29:1-22.

4. Anderson DJ, Sexton DJ. Antimicrobial prohylaxis for prevention of surgical site infection in adults 2017 10 February 2021. Available from:

5. BerrĂ­os-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surgery. 2017;152(8):784-91.

6. Michael R, Hartigan L, Murphy M. Methods of achieving and maintaining an appropriate caesarean section rate. Best Pract Res Clin Obstet Gynaecol. 2013;27(2):297-308.

7. American College of Obstetricians and Gynecologists. Use of prophylactic antibiotics in labor and delivery. ACOG Practice Bulletin [Internet]. 2018; 132(3):[e103-19 pp.].

8. Smaill FM, Gyte GML. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev. 2010;2014(10):CD007482.

9. Nagarashi RD, Kshirsagar NS, Jadhav AJ, Patange RP. Comparative evaluation of single dose of prophylactic antibiotics against the post-operative antibiotic therapy in lower segment caesarean section. Int J Contemp Med Res. 2016;3(6):1609-11.

10. Different classes of antibiotics given to women routinely for preventing infection at cesarean section [Internet]. Cochrane Database of Systematic Rreview. 2014; 2014(11):CD008726..

11. Kementerian Kesehatan Republik Indonesia [Indonesian Ministry of Health]. Pedoman umum penggunaan antibiotik [General guideline of antibiotic use]. In: Health Mo, editor. Jakarta: Ministry of Health; 2011.

12. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm. 2013;70(3):195-283.

13. Herawati F, Yulia R, Hak E, Hartono AH, Michiels T, Woerdenberg HJ, et al. A retrospective surveillance of the antibiotic prophylactic use of surgical procedures in private hospitals in Indonesia. Hosp Pharm. 2019;54(5):323-9.

14. Shaheen S, Akhtar S. Comparison of single dose versus multiple antibiotic prohylaxis in elective caesarean section. J Postgrad Med Inst. 2014;28(1):83-6.

15. Muzayyanah B, Yulistiani Y, Hasmono D, Wisudani N. Analysis of prophylactic antibiotics usage in caesarean section delivery. Fol Med Indones. 2018;54(3):161-6.

16. Aisyah E, Nadjib M. Evaluasi ekonomi penggunaan antibiotik profilaksis cefotaxime dan ceftriaxone pada pasien operasi seksio sesarea di Rumah Sakit X. Jurnal Ekonomi Kesehatan Indonesia. 2018;3(2):57-67.

17. Lyimo FM, Massinde AN, Kidenya BR, Konje ET, Mshana SE. Single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post-caesarean section at Bugando Medical Centre in Mwanza, Tanzania: a randomized, equivalence, controlled trial. BMC Pregnancy Childbirth. 2013;13:123.

18. Pore SM, Sardesai SP, Tapare VS, Kulkarni MV, Malhotra AP, Chavan CS. Single dose of cefazolin plus metronidazole versus existing multi-dose regimen for prophylaxis in caesarean section. Indian J Pharmacol. 2012;44(2):279-80.

19. Shah Z, Kshirsagar NS, Shah S. Comparison of single dose prophylactic antibiotics versus five days antibiotic in cesarean section. J Evo Med Dent Sci. 2014;3(12):3123-9.

20. Lamont RF, Sobel JD, Kusanovic JP, Vaisbuch E, Mazaki-Tovi S, Kim SK. Current debate on the use of antibiotic prophylaxis for caesarean section. BJOGBr J Obstet Gynaecol. 2011;118(2):193-201.

21. Pinto-Lopes R, Sousa-Pinto B, Avezedo LF. Single dose versus multiple dose of antibiotic prophylaxis in caesarean section: a systematic review and meta-analysis. Br J Obstet GynaecolBJOG. 2016;124(4):595-605.

22. Liu D, Zhang L, Zhang C, Chen M, Zhang L, Li J, et al. Different regimens of penicillin antibiotics given to women routinely for preventing infection after cesarean section: a systematic review and meta analysis. Medicine. 2018;97(46):e11889.

23. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 120: use of prophylactic antibiotics in labor and delivery. Obstet Gynecol. 2011;117(6):1472-83.

24. Gholitabar M, Ullman R, James D, Griffiths M. Caesarean section: summary of updated NICE guidance. BMJ. 2011;343:d7108.

25. Enzler MJ, Berbari E, Osmon DR. Antimicrobial prophylaxis in adults. Mayo Clin Proc. 2011;86(7):686-70.

26. Spagnolo AM, Ottria G, Arnicizia D, Perdelli F, Cristina ML. Operating theatre quality and prevention of surgical site infection. J Prev Med Hyg. 2013;54(3):131-7.

27. Majumder MAA, Rahman S, Cohall C, Singh K, Haque M, Hilaire MG-S. Antimicrobial stewardship: fighting antimicrobial resistance and protecting global public health. Infect Drug Resist. 2020;13:4713-38.

28. Jansson MH, Cao Y, Nillson K, Larsson PG, Hagberg L. Cost-effectiveness of antibiotic prophylaxis in elective cesarean section. Cost Eff Resourc Alloc. 2018;16(66):1-8.
How to Cite
PERTIWI, Bayu et al. Cost-Effective Analysis of Ceftriaxone as Prophylactic Antibiotic in Caesarean Section: Single Dose Versus Multiple Dose. JURNAL ILMU KEFARMASIAN INDONESIA, [S.l.], v. 20, n. 2, p. 175-183, oct. 2022. ISSN 2614-6495. Available at: <>. Date accessed: 08 feb. 2023. doi: