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The most common indication for antibacterial chemoprophylaxis is to reduce the risk of surgical infection. Appropriate use of antibacterial is effective in the prevention of surgical site infections, but inappropriate prescribing and excessive use of such drugs increases the cost of therapy, as well as the risk of antibacterial resistance.To study the cost burden of inappropriate peri-operative antibacterial use in a teaching tertiary-care rural hospital in India.A prospective observational study of 200 patients from four surgical departments was conducted from February to October 2010. Data were analysed for class of surgical wound, and the use, appropriateness and cost burden of peri-operative antibacterial therapy.The majority of patients (45.5 %) had class II surgical wounds followed by Class I (26 %), Class III (17.5 %) and Class IV (11 %). In 143 patients with class I or II surgical wounds, inappropriate peri-operative antibacterials were prescribed in 119 (83.2 %) patients. Among these 119 patients, the choice of antibacterial was inappropriate in 76.5 % of patients, the duration of treatment was inappropriate in all patients, and the mean antibacterial cost was Indian rupee 541.29, which was significantly (p < 0.001) higher than calculated ideal cost of 49.3.Inappropriate peri-operative prescribing of antibacterials is a common problem culminating in an increased cost burden. Interventions are warranted to promote the development, dissemination and adoption of evidence-based standard treatment guidelines for antibacterial prophylaxis.