Surgeons’ Knowledge, Attitudes, and Practices Toward Post-Operative Prophylactic Oral Antibiotic Use after Cleft Lip Repair

Objective To evaluate surgeons’ knowledge, attitudes, and self-reported practices regarding prophylactic oral antibiotic use following cleft lip repair. Design Descriptive cross-sectional survey study. Setting Cleft workshop, November 2025. Participants Surgeon attendees. Interventions A 19-item survey assessing demographics, knowledge, attitudes, and practices related to prophylactic antibiotic use. Main Outcome Measures Surgeons’ knowledge, attitudes, and perceptions regarding post-operative antibiotics, and self-reported prescribing practices after cleft lip repair. Results A total of 108 surgeons from multiple countries and resource settings participated. Most agreed that prophylactic post-operative oral antibiotics reduce infection rates in any setting (42.5%) and low-resource settings (49.1%), while 41.6% disagreed that sufficient evidence supports their use in any setting. Most participants (67.6%) acknowledged that antibiotic overuse contributes to antimicrobial resistance. Among the 93 prescribers, decisions were primarily based on oral hygiene (82.8%), followed by location (47.3%) and family literacy (46.2%). Prevention of wound infection was the main reason for prescribing (92.5%). Practice resource level was significantly associated with prescribing behavior (Fischer's exact P = 0.001), whereas surgical specialty, years in practice, and annual cleft lip repair volume were not. The association remained significant in binary logistic regression (Wald χ 2 =10.496, df = 2, P = 0.005). Surgeons in medium-resource settings had greater odds of prescribing than those in high-resource settings (OR = 10.84, P = 0.001). Conclusions There is a disconnect between evidence and practice, with substantial variability in prescribing attitudes and behaviors. Further research and standardized guidelines are needed to promote judicious antibiotic use in cleft care.