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Peer-reviewedCC BY 4.0Frontiers in Antibiotics

Ceftriaxone-by-default in surgical prophylaxis across the East African community: a measurement problem

  • Samar Rashid Abdullahi1,2
  • Nathan Mugenyi3
  • Lucy Ochola1
  • Jamal Abade Mohamed2
  • Hussein Iman Sigat4
  • Abdirizak Ali Yusuf5
  • Wigilya P. Mikomangwa6
  • Armstrong Ndihokubwayo7
  • David Majuch Kunjok8,9
  • Schifra Uwamungu10
  • Nathan Banzi11
  • Barbra Tuhamize11,12,13
13 affiliations
  1. 1Human Health Department, One Health Antimicrobial Resistance Network (OHAAN), Nairobi, Kenya
  2. 2Medical Department, Wajir County Referral Hospital, Wajir, Kenya
  3. 3Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
  4. 4Surgical Department, Garissa County Referral Hospital, Garissa, Kenya
  5. 5Infectious Disease Department, National Institute of Health, Mogadishu, Somalia
  6. 6Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  7. 7National Reference Laboratory, National Institute of Public Health, Bujumbura, Burundi
  8. 8Department of Environmental Health and Disease Control, School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
  9. 9Expanded Programme on Immunization (EPI), Ministry of Health, Juba, South Sudan
  10. 10Biomedical Laboratory Sciences Department, School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
  11. 11Department of Microbiology and Parasitology, Faculty of Health Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
  12. 12South 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
  13. 13Department 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
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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.

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Cite

BibTeXRIS
BibTeX
@article{abdullahi2026ceftriaxonebydefault,
  title = {{Ceftriaxone-by-default in surgical prophylaxis across the East African community: a measurement problem}},
  author = {Samar Rashid Abdullahi and Nathan Mugenyi and Lucy Ochola and Jamal Abade Mohamed and Hussein Iman Sigat and Abdirizak Ali Yusuf and Wigilya P. Mikomangwa and Armstrong Ndihokubwayo and David Majuch Kunjok and Schifra Uwamungu and Nathan Banzi and Barbra Tuhamize},
  journal = {Frontiers in Antibiotics},
  year = {2026},
  month = oct,
  doi = {10.3389/frabi.2026.1968363},
  url = {https://doi.org/10.3389/frabi.2026.1968363},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Ceftriaxone-by-default in surgical prophylaxis across the East African community: a measurement problem
AU  - Samar Rashid Abdullahi
AU  - Nathan Mugenyi
AU  - Lucy Ochola
AU  - Jamal Abade Mohamed
AU  - Hussein Iman Sigat
AU  - Abdirizak Ali Yusuf
AU  - Wigilya P. Mikomangwa
AU  - Armstrong Ndihokubwayo
AU  - David Majuch Kunjok
AU  - Schifra Uwamungu
AU  - Nathan Banzi
AU  - Barbra Tuhamize
PY  - 2026
DA  - 2026/10/12
JO  - Frontiers in Antibiotics
DO  - 10.3389/frabi.2026.1968363
UR  - https://doi.org/10.3389/frabi.2026.1968363
AB  - 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.
SN  - 2813-2467
ER  -