Rethinking Antibiotic Prophylaxis in Surgery / Nehad Jaser Ahmed

 

Rethinking Antibiotic Prophylaxis in Surgery

Nehad Jaser Ahmed

Surgical site infections (SSIs) remain a major healthcare concern, increasing hospital stays, costs, and patient complications. Although antibiotic prophylaxis is essential for preventing SSIs, the choice of antibiotic is critical. In recent years, broader-spectrum cephalosporins such as ceftriaxone have been increasingly used, often without strong evidence that they provide superior protection compared to narrower options like cefazolin.

Across multiple large-scale analyses, the findings were consistent:

  • Cefazolin is as effective as broader-spectrum cephalosporins (e.g., cefuroxime, ceftriaxone) in preventing SSIs across clean, clean-contaminated, and contaminated surgeries.
  • Broader-spectrum antibiotics do not reduce infection rates compared to cefazolin.
  • Overuse of broad-spectrum agents remains common in real-world surgical practice.
  • Such overuse increases antimicrobial resistance risk, costs, and unnecessary drug exposure.

Importantly, when antimicrobial stewardship programs were implemented—through guideline enforcement, education, and prescription review—significant improvements were observed:

  • More appropriate antibiotic selection
  • Better timing and duration of prophylaxis
  • Reduced antibiotic consumption
  • Lower SSI rates
  • Decreased healthcare costs

Overall, the combined evidence demonstrates that smarter antibiotic selection—not broader coverage—is key to effective surgical infection prevention. Cefazolin remains a reliable, cost-effective first-line option, and stewardship programs play a crucial role in aligning clinical practice with evidence-based recommendations.

The central message is clear: improving surgical outcomes does not require stronger antibiotics, but rather appropriate, evidence-based use.

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