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However, the same women are likely to be the first to suffer from an increase in antibiotic resistance. New antibiotics needed to meet the challenge of resistance are often more expensive than the predecessor and this is likely to increase the challenge for vulnerable groups to afford treatment with antibiotics in a setting where most maternal health care is paid out-of-pocket [18]. The results from this study show high rates of antibiotic prescribing for both women that had a vaginal delivery and women that had a cesarean section. In the group of women who had a vaginal delivery 491 women (87%) were prescribed antibiotics and in the group of women who had a cesarean section 503 (98%t) were prescribed antibiotics. buy Duvelisib As a comparison, resent figures from the Christian Medical College (CMC) in Vellore, Tamil Nadu, India showed that among women with PRDX4 a vaginal delivery 22% were prescribed antibiotics and among women having a cesarean section the most commonly prescribed antibiotic was a single dose of cefazolin (Prof S. Chandy, Christian Medical College, Vellore, personal communication). The CMC, Vellore is, in resemblance with the VD Gardi Charitable Trust Hospital, a non-teaching, tertiary hospital that caters both rural and urban population. One difference though is that the CMC, has a general policy on antibiotic prescribing and an active implementation of the policy since long. This DNA/RNA Synthesis inhibitor indicates that having a policy on antibiotic prescribing and an active implementation of the policy can have an impact on how antibiotics are prescribed also during delivery in hospitals, and can serve as an inspiration for other hospitals in the Indian setting to develop and implement such policy. Women undergoing cesarean section have a five to 20-fold greater chance of getting an infection compared to women who give birth vaginally, and the routine use of antibiotics at cesarean section reduces the risk of infection [19]. In cesarean section, post-operative infections are likely to be caused by Staphylococcus-epidermidis, Staphylococcus aureus, Group B Streptococci or Enterococcus. The result from the study, showing that 98% of the women having a cesarean section were prescribed antibiotics are therefore not surprising and in line with WHO recommendation. What the study shows, however, is that in the setting studied the type and dose of the prescribed antibiotics differs from the recommendations made by the WHO. The WHO recommends a single dose of cefazoline, a first generation cephalosporin [20,21]. In the setting studied, third generation cephalosporins (J01DD) were prescribed in 30% of the cases, followed by combinations of antibiotics (J01RA) prescribed in 30% of the cases, and fluoroquinolones (J01MA) prescribed in 13% of the cases. Only 2% were prescribed first generation cephalosporins.