When Do You Need Antibiotics Before Surgery?

One of the most common questions patient ask before surgery is whether or not they will require antibiotics. Antibiotics are important when indicated, but it is commonly aware that the overuse of antibiotics will leads to the development of resistant organisms. An article in the current issue of Plastic and Reconstructive Surgery addresses this question for the plastic surgery patient. A panel selected by the American Association of Plastic Surgeons performed a meta-analysis of the existing literature and selected 67 studies. The conclusions were as follows:

  1. Prophylactic antibiotics are not recommended to reduce infection in clean surgical cases of the skin, the head and neck, the hand and in abdominoplasty.
  2. Systemic prophylactic antibiotics are recommended for:
    1. clean breast surgery
    2. hand surgery (if contaminanted only)
    3. head and neck surgery (if contaminated only)

What was left unanswered is what regimen constitutes prophylactic antibiotics. Generally, in my practice, the protocol for prophylactic antibiotics requires two doses of intravenous antibiotics. One is given after the IV is placed but before the surgery begins. The second is given in the recovery room.

There may be some other special situations that will require prophylactic antibiotics such as the presence of certain orthopedic or cardiac implants. For the most part, however, the recommendations of the consensus panel probably represent the best of current evidence based medicine.