Guidelines for Surgical Antibiotic Prophylaxis

Core Principles of Surgical Antibiotic Prophylaxis

Surgical antibiotic prophylaxis (SAP) should be administered as a single dose within 30-60 minutes before surgical incision, with specific antibiotics targeted to likely pathogens, and generally should not be continued beyond the operative period 1, 2
SAP should be administered for procedures with high risk of postoperative surgical site infection (SSI) or when foreign materials are implanted 1, 2
Antibiotics should target the most likely contaminants - typically gram-positive skin commensals or normal flora colonizing incised mucosae 1
Administration timing is critical: within 120 minutes before incision, but ideally 30-60 minutes before incision for most antibiotics 1, 3
For vancomycin, infusion should begin early enough to be completed 30 minutes before the procedure 3
Redosing is required for procedures lasting longer than 2-4 hours (depending on the antibiotic's half-life) or with significant blood loss (>1.5L) 1, 2
There is no evidence supporting postoperative antibiotic prophylaxis for most procedures 1, 2

For orthopedic surgery, such as joint prosthesis/implants, cefazolin 2g IV (1g if >4h), cefamandole 1.5g IV (0.75g if >2h), or cefuroxime 1.5g IV (0.75g if >2h) should be used 6
For neurosurgery, such as craniotomy/CSF shunt, cefazolin 2g IV (1g if >4h) should be used 5
For digestive surgery, such as biliary tract/gastroduodenal surgery, cefazolin 2g IV, cefuroxime 1.5g IV, or cefamandole 1.5g IV should be used 6
For obstetrics & gynecology, such as cesarean section, cefazolin 2g IV (single dose) should be used 7
For bariatric surgery, doses should be calculated based on actual weight 7

Patients ≥120kg require higher doses of antibiotics 1, 2
For bariatric surgery: cefazolin 4g (30-min infusion) or cefuroxime 3g (30-min infusion) should be used 7
Vancomycin infusion must be completed at least 30 minutes before incision 4
Vancomycin is indicated for allergy to beta-lactams, suspected or proven colonization by methicillin-resistant staphylococci, reoperation in a patient hospitalized in a unit with MRSA ecology, and previous antibiotic therapy 4, 3

Proper hand hygiene practices should be followed 1
Meticulous surgical techniques and minimization of tissue trauma should be used 1
Appropriate hospital and operating room environments should be maintained 1
Proper instrument sterilization processes should be followed 1
Perioperative optimization of patient risk factors should be performed 1
Appropriate management of surgical wounds should be done 1
Perioperative temperature, fluid, and oxygenation management should be maintained 1
Targeted glycemic control should be used 1