{
  "abstract": "Surgical antibiotic prophylaxis across the East African Community is dominated by ceftriaxone, a WHO Access, Watch, and Reserve (AWaRe) Watch-group third-generation cephalosporin not recommended for routine prophylaxis. The practice recurs across regional point prevalence surveys, yet consumption surveillance cannot distinguish prophylactic from therapeutic use. Drawing on antimicrobial-use surveys, surgical-prophylaxis studies, resistance surveillance, and medicine-availability reports, we argue that four interacting failure modes sustain it: substitution of first-line agents, prolongation of postoperative prophylaxis, unnecessary combination, and empirical spillover from ward prescribing. Resistance among surgical-site isolates is already high enough to threaten the value of prophylaxis itself. Prophylaxis is measured for duration, documented indication, and guideline concordance, and agent choice is captured in point-prevalence surveys, but none of this reaches the national consumption totals that govern procurement, and no indicator records the supply constraint determining the agent or the resistance it selects. We propose four measures, one requiring routing rather than building and three genuinely absent, that would convert an ungoverned practice into a governable one.",
  "abstract_shown": true,
  "affiliations": [
    "Human Health Department, One Health Antimicrobial Resistance Network (OHAAN), Nairobi, Kenya",
    "Medical Department, Wajir County Referral Hospital, Wajir, Kenya",
    "Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda",
    "Surgical Department, Garissa County Referral Hospital, Garissa, Kenya",
    "Infectious Disease Department, National Institute of Health, Mogadishu, Somalia",
    "Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania",
    "National Reference Laboratory, National Institute of Public Health, Bujumbura, Burundi",
    "Department of Environmental Health and Disease Control, School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya",
    "Expanded Programme on Immunization (EPI), Ministry of Health, Juba, South Sudan",
    "Biomedical Laboratory Sciences Department, School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda",
    "Department of Microbiology and Parasitology, Faculty of Health Sciences, Mbarara University of Science and Technology, Mbarara, Uganda",
    "South African Medical Research Council–University of Venda Antimicrobial Resistance and Global Health Research Unit (SAMRC-UNIVEN) Antimicrobial Resistance and Global Health Research Unit, Institute for Pathogen and Global Health Research, University of Venda, Thohoyandou, South Africa",
    "Department of Science, Technology and Innovation (DSTI) / National Research Foundation (NRF) South African Research Chairs Initiative (SARChI), Institute for Pathogen and Global Health Research, University of Venda, Thohoyandou, South Africa"
  ],
  "article_type": "brief report",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Samar Rashid Abdullahi"
    },
    {
      "affs": [
        2
      ],
      "name": "Nathan Mugenyi"
    },
    {
      "affs": [
        0
      ],
      "name": "Lucy Ochola"
    },
    {
      "affs": [
        1
      ],
      "name": "Jamal Abade Mohamed"
    },
    {
      "affs": [
        3
      ],
      "name": "Hussein Iman Sigat"
    },
    {
      "affs": [
        4
      ],
      "name": "Abdirizak Ali Yusuf"
    },
    {
      "affs": [
        5
      ],
      "name": "Wigilya P. Mikomangwa"
    },
    {
      "affs": [
        6
      ],
      "name": "Armstrong Ndihokubwayo"
    },
    {
      "affs": [
        7,
        8
      ],
      "name": "David Majuch Kunjok"
    },
    {
      "affs": [
        9
      ],
      "name": "Schifra Uwamungu"
    },
    {
      "affs": [
        10
      ],
      "name": "Nathan Banzi"
    },
    {
      "affs": [
        10,
        11,
        12
      ],
      "name": "Barbra Tuhamize"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6vjh6bpyrknts.bib",
  "cited_by": 0,
  "doi": "10.3389/frabi.2026.1968363",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13697196/",
  "id": "6vjh6bpyrknts",
  "issns": [
    "2813-2467"
  ],
  "landing_url": "https://doi.org/10.3389/frabi.2026.1968363",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Perspective"
    ],
    [
      "openalex",
      "2402|Antibiotic Use and Resistance"
    ]
  ],
  "openalex": "W7221572610",
  "pdf_url": "https://europepmc.org/articles/PMC13697196?pdf=render",
  "pmcid": "PMC13697196",
  "pmid": "42935822",
  "published": "2026-10-12",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/6vjh6bpyrknts.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:17Z",
      "native_id": "PMC13697196",
      "source": "pmc",
      "url": "https://doi.org/10.3389/frabi.2026.1968363"
    },
    {
      "first_seen": "2026-10-30T12:22:24Z",
      "native_id": "MED:42935822",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42935822"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "openalex:2402|Antibiotic Use and Resistance",
      "subfield": "microbiology"
    }
  ],
  "title": "Ceftriaxone-by-default in surgical prophylaxis across the East African community: a measurement problem",
  "title_text": "Ceftriaxone-by-default in surgical prophylaxis across the East African community: a measurement problem",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:34:16Z",
  "url": "https://research.draconitic.com/paper/6vjh6bpyrknts",
  "venue": "Frontiers in Antibiotics",
  "versions": []
}