Postoperative antibiotics do not reduce surgical site infections after clean thyroid and breast surgery: A randomised controlled trial from a resource-constrained setting
Restricted accessResearch articleFirst published online 2026
Postoperative antibiotics do not reduce surgical site infections after clean thyroid and breast surgery: A randomised controlled trial from a resource-constrained setting
Elective thyroid and breast procedures are classified as clean surgery, yet prolonged postoperative antibiotic use remains common in many low- and middle-income settings despite guideline recommendations, contributing to unnecessary antimicrobial exposure. We conducted a randomised trial in a public tertiary-care hospital in central India, assigning adults undergoing elective clean thyroid or breast surgery to either three days of postoperative antibiotics or no antibiotics beyond a single pre-incision prophylactic dose. The primary outcome was 30-day surgical site infection.
PhillipsBTBishawiMDagumAB, et al.A systematic review of antibiotic use and infection in breast reconstruction: what is the evidence?Plast Reconstr Surg. 2013; 131: 1–13. doi: 10.1097/PRS.0b013e3182729c39
Berríos-TorresSIUmscheidCABratzlerDW, et al.Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg2017; 152: 784–791.
5.
StallardSSavioliFMcConnachieA, et al.Antibiotic prophylaxis in breast cancer surgery (PAUS trial): Randomised clinical double-blind parallel-group Multicentre superiority trial. Br J Surg2022; 109: 1224–1231.
6.
SattarAKMasroorTMartinsRS, et al.Impact of postoperative antibiotic prophylaxis on surgical site infections rates after mastectomy with drains but without immediate reconstruction: a multicenter, double-blinded, randomized control superiority trial. Ann Surg Oncol2023; 30: 5965–5973.
7.
CruzHSCakmakGKMathelinC, et al.Antibiotic prophylaxis in breast cancer surgery: A multicontinental survey study. J Surg Res2024; 302: 281–285.
8.
MurrayCJLIkutaKSShararaF, et al.Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet2022; 399: 629–655.
9.
GuptaRBhatiaR. Antimicrobial resistance in India: The road ahead. In: MothadakaMPRavishankarCNVaiyapuriM, etal (eds) Handbook on Antimicrobial Resistance: Current Status, Trends in Detection and Mitigation Measures. Singapore: Springer Nature Singapore, 2023, pp.3–20. doi:https://doi.org/10.1007/978-981-16-9723-4_1-2
10.
ShindeAMohanABulusuVM, et al.Current status of antimicrobial resistance in Indian healthcare system: Combating antimicrobial resistance with precision medicine. Front Antibiot2026; 5: 1632790.
11.
ShkedyYSternSNachalonY, et al.Antibiotic prophylaxis in clean head and neck surgery: A prospective Randomised controlled trial. Clin Otolaryngol2018; 43: 1508–1512.
12.
DegnimACScowJSHoskinTL, et al.Randomized controlled trial to reduce bacterial colonization of surgical drains after breast and axillary operations. Ann Surg2013; 258: 240–247.
13.
EdwardsBLStukenborgGJBreninDR, et al.Use of prophylactic postoperative antibiotics during surgical drain presence following mastectomy. Ann Surg Oncol2014; 21: 3249–3255.
14.
GiguèreGBPoirierBProvencherL, et al.Do preoperative prophylactic antibiotics reduce surgical site infection following wire-localized lumpectomy? A single-blind randomized clinical trial. Ann Surg Oncol2022; 29: 2202–2208.
15.
LiuLJianZWangM, et al.Is antibiotic prophylaxis generally safe and effective in surgical and nonsurgical scenarios? Evidence from an umbrella review of randomized controlled trials. Int J Surg2024; 110: 1224–1233.
16.
UrunoTMasakiCSuzukiA, et al.Antimicrobial prophylaxis for the prevention of surgical site infection after thyroid and parathyroid surgery: a prospective randomized trial. World J Surg2015; 39: 1282–1287.
17.
PrudencioRMACamposFSMLoyolaABAT, et al.Antibiotic prophylaxis in breast cancer surgery. A randomized controlled trial. Acta Cir Bras2020; 35: e202000907.
18.
de JongeSWBoldinghQJJSolomkinJS, et al.Effect of postoperative continuation of antibiotic prophylaxis on the incidence of surgical site infection: A systematic review and meta-analysis. Lancet Infect Dis2020; 20: 1182–1192.
19.
KleinEYVan BoeckelTPMartinezEM, et al.Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci U S A2018; 115: E3463–E3470.
