Pendahuluan: Peresepan antibiotik pra-pembedahan (profilaksis) merupakan penggunaan antibiotik yang sering dijumpai di rumah sakit dan pengendalian penggunaannya sangat penting namun belum banyak diteliti di Indonesia. Berdasarkan data dari surveillans audit bundles pencegahan Infeksi Daerah Operasi di RS X periode Oktober-Desember 2023, didapatkan kesesuaian jenis antibiotik profilaksis maupun ketepatan waktu pemberian antibiotik profilaksis 30-60 menit sebelum insisi masih di bawah 60%. Metodologi: Penelitian dilakukan untuk menganalisis kesesuaian dan rasionalitas peresepan antibiotik profilaksis serta melakukan evaluasi penyebab ketidaksesuaian. Penelitian dilakukan dalam dua tahap yaitu deskriptif kuantitatif dan kualitatif dengan wawancara semi terstruktur. Hasil: Penelitian ini didapat capaian kesesuaian peresepan antibiotik profilaksis masih kurang dari 60%.  Dari analisis faktor yang mempengaruhi perilaku didapatkan kapabilitas dan kesempatan sudah baik namun kekhawatiran risiko infeksi dan keluarah hasil operasi mempengaruhi motivasi untuk memberikan antibiotik profilaksis secara bijak. Kesimpulan: Capaian kesesuaian peresepan antibiotik profilaksis masih rendah (< 60%) dengan variasi yang tinggi karena belum tersedianya prosedur detail. Ketidakpatuhan tertinggi ditemukan pada kelompok ortopedi terkait indikasi dan durasi pemberian. Meskipun tingkat kepatuhan rendah, tidak ditemukan kejadian Infeksi Daerah Operasi (IDO) pada seluruh subjek. Ketidakpatuhan dokter dipicu oleh kekhawatiran terhadap hasil operasi dan skeptisisme atas efektivitas antibiotik lini pertama, yang lebih memprioritaskan keamanan pasien jangka pendek dibandingkan risiko resistensi antimikroba. Oleh karena itu, pimpinan rumah sakit perlu melakukan intervensi secara sistematis dan menerapkan pemantauan menyeluruh untuk meningkatkan peresepan antibiotik profilaksis sesuai standar.

Introduction: The use of presurgical antibiotics is common, but adherence to guideline is low. Improper use can lead to antibiotic resistance. A preliminary study was conducted at Hospital X between October and December 2023. The study found that the correct type of antibiotic and the timing of administration (30-60 minutes before incision) were both below 60% adherence. Research objectives is to analyze the appropriateness and rationality of pre-surgical antibiotics prescriptions and to evaluaste the causes of noncompliance. The research used a mixed-methods approach. Descriptive statistics to analyze prescribing patterns. Semi-structured interviews to understand the reasons behind prescribing practices. Research finding: Adherence to prescribing guidelines for antibiotic prophylaxis was less than 60%. While doctors had the capability and opportunity to prescribe correctly, concerns about infection risk and surgical outcomes influenced their motivation, leading to potentially less judicious use of antibiotics. The study concludes that compliance with prophylactic antibiotic prescribing remains low (< 60%), characterized by significant practice variation due to the absence of detailed procedural guidelines. The lowest compliance was observed within the orthopedic group regarding indications and duration of administration. Despite low adherence, no Surgical Site Infections (SSI) were reported across all subjects. Clinician non-compliance is driven by concerns over surgical outcomes and skepticism regarding the efficacy of first-line antibiotics, prioritizing immediate patient safety over the long-term risk of antimicrobial resistance. Consequently, hospital leadership must implement systematic interventions and comprehensive monitoring to align prophylactic antibiotic prescribing with established standards.  Key words: antibiotic prophylaxis, appropriateness, rationality,  behaviour