A two-part continuing-education review in the Journal of the American Academy of Dermatology, published on 21 September 2026, brings together current guidance on antibiotic use around excisional skin surgery, Mohs surgery and reconstruction. Part 1 covers who needs systemic prophylaxis.
The starting point is that dermatological surgery is mostly clean surgery with a low baseline infection rate. The review supports a risk-stratified approach that weighs the procedure, the anatomical site and the patient, with particular attention to people with high-risk cardiac conditions, prosthetic joints, immunosuppression and transplants. It notes that topical antibiotics are generally unnecessary on clean wounds, where petrolatum performs well, and that intra-incisional antibiotics are an option in higher-risk cases instead of oral courses.
This is a narrative educational review rather than a new trial or guideline, so it consolidates existing advice. Its value is as a checklist against a common default: a course of oral antibiotics after every excision. In India, where topical and oral antibiotics are easily obtained and resistance is high, the stewardship argument is stronger still.
- Reserve systemic prophylaxis for defined high-risk patients, sites and procedures
- Check for high-risk cardiac conditions, prosthetic joints and immunosuppression before surgery
- Use plain petrolatum rather than topical antibiotics on clean surgical wounds
- Consider intra-incisional antibiotic in higher-risk cases instead of an oral course
- Record the reason whenever prophylaxis is given
Why it matters
Routine post-excision antibiotics add side effects and resistance for little gain in clean surgery.
Don't overread it
This is an educational review that restates guidance, not new trial evidence.
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