Excessive and inappropriate use broad spectrum antibiotics for surgical prophylaxis has led to development antimicrobial resistance, reduced treatment efficacy, a rise in morbidity and mortality and increased costs. The aim of this study is to assess magnitude of appropriate use and adherence of antimicrobial usage in surgical prophylaxis to the clinical antibiotics prophylaxis guidelines Objective:To assess magnitude of appropriate use of surgical antibiotic prophylaxis and associated factors among surgical operated patients in Tibebe Ghion Specialized Hospital, Bahirdar city, Ethiopia, 2023 Methods: Hospital based cross-sectional study of all patients operated in general surgery wards in TGSH BahirDar city from January to August 2023 was conducted.Systematic sampling technique by was used and the final sample size for the study was 422.The data was collected using standard check list and using patient’s medical record, inpatient and outpatient registry book, and OR logbook as a source of data. The collected data was entered into SPSS 27 for analysis. Bivariate and multivariate logistic regression was done at p-value 0.05 and model fitness was cheeked using hosmer and lemeshow. Binary regression model was used. The result is presented in tables, charts and graphs. Results: A total of 412 patients medical records were evaluated and out of them 355(86.2%) of cases received prophylactic antibiotics. Among the patients for whom prophylaxis administered, 79(22.3%) of prescriptions were appropriate. Ceftriaxone and metronidazole were most commonly prescribed prophylactic agents in 209(58.9%)The mostcommon reasons for appropriate prophylaxis were dosage, 355(100%), indication, 328(92.4%), duration of administration, 238(67%), choice of antibiotics, 110(31%) and timing of administration, 91(25.6%). Availability of first line prophylactic antibiotics is 16.8 times increased appropriateness of surgical antibiotic prophylaxis use than non-availability at the time of prescription (AOR95%CI=16.834(7.687-36.865, p=0.01). Patients after prostatectomy received prophylactic antibiotics 4.115 times appropriately than patients after cholecystectomy (AOR=4.115(95%CI, 1.404-12.048, p-value=0.010)). Patients for whom thyroidectomy done received SAP 23.255 times appropriately than patients after cholecystectomy (AOR=23.255(95%CI, 2.967-71.428, p value=0.001)) and patients after hernia repair received 48.64times more appropriately than patients after cholecystectomy (AOR=48.64(95%CI, 10.622-222.144, p value=0.000)) Conclusions: Appropriate use of surgical antibiotic prophylaxis is low in surgical wards of TGSH and ceftriaxone and metronidazole were most common prescriptions as surgical prophylaxis. To improve appropriate use, ensure availability of first line antibiotics, provision of continuouseducation and escalation of short-term training of prescribers for appropriate use ofantibiotics and preparation of local surgical antibiotics prophylaxis guidelines and protocols should be considered. Key words: Surgical antibiotic prophylaxis, surgical ward, BahirDar University