A two-part continuing-education review in JAAD (published 21 September) brings together the evidence on antibiotic prophylaxis for excisional dermatologic surgery, including standard excisions, Mohs surgery and reconstruction. Part 1 covers indications and special populations.
The review restates that most skin surgery is clean, with low baseline infection rates, and that routine systemic prophylaxis is not indicated. It sets out a risk-stratified approach based on the procedure, the site and the patient, including those with high-risk cardiac conditions, prosthetic joints and immunosuppression such as transplant recipients. For clean wounds, plain petrolatum is recommended over topical antibiotic ointment, and intra-incisional antibiotic is discussed as an alternative to oral antibiotics in higher-risk cases.
Antibiotics are still prescribed out of habit after many minor procedures, and topical antibiotic ointments add allergy and resistance risk without benefit on clean wounds. Applying a written, risk-based policy in clinic is the change.
- Do not prescribe routine systemic antibiotics for clean excisional or Mohs surgery.
- Use plain petrolatum, not a topical antibiotic, on clean surgical wounds.
- Consider prophylaxis for defined high-risk patients, such as some with prosthetic heart valves or significant immunosuppression, following current cardiac and orthopaedic guidance.
- Weigh anatomical site and procedure complexity alongside patient factors when deciding.
- Write a clinic policy so the decision is consistent across clinicians.
Why it matters
Habitual post-procedure antibiotics and antibiotic ointments add allergy and resistance risk without preventing infection on clean wounds.
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