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.
