A JAAD continuing-education review brings together the evidence on antibiotic prophylaxis for excisional skin surgery, including Mohs and reconstruction. Its starting point is that these are clean procedures with low baseline infection rates.
Systemic prophylaxis is reserved for defined situations: high-risk cardiac conditions such as prosthetic valves, some patients with prosthetic joints, immunosuppression including transplant, and higher-risk anatomical sites or reconstructions. Topical antibiotics are generally unnecessary on clean wounds; petrolatum works as well. Where infection risk is higher, intra-incisional antibiotic is an alternative to an oral course.
This is a review rather than a trial, and it reflects existing guidance. The practice change is for units that still prescribe prophylaxis or topical antibiotic by habit.
- Do not prescribe oral antibiotic prophylaxis for routine excisions.
- Check for prosthetic valves, prior endocarditis, recent joint replacement and immunosuppression before surgery.
- Use petrolatum rather than topical antibiotic on clean wounds.
- Consider intra-incisional antibiotic for higher-risk sites instead of an oral course.
- Audit your own prescribing for a month — habit prophylaxis is common.
Why it matters
Unneeded antibiotics after skin surgery add side effects and resistance without reducing infections.
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