Perioperative Antibiotic Prophylaxis: A Critical Review

BACKGROUND: The value of perioperative prophylaxis is established for clean-contaminated procedures. For clean surgery, prophylaxis traditionally has been reserved for prosthetic device implantation procedures. METHODS: Review of pertinent English-language literature. CURRENT RECOMMENDATIONS: Evidence suggests that prophylactic antibiotics are advisable for at least some non-prosthetic procedures and that glycopeptides might have a role for major prosthetic surgery in units with a high prevalence of methicillin-resistant Staphylococcus aureus. In clean-contaminated surgery, cefazolin is recommended, although not for colorectal procedures or obstetric/gynecologic surgery that requires anti-anaerobic coverage. CONCLUSION: Antibiotic prophylaxis is generally overprescribed (i.e., given for too long). Short-duration prophylaxis is effective and safe.