For most clean and clean-contaminated operations, a single preoperative dose of the right antibiotic, given within an hour before incision and redosed for long procedures, provides the protection. Continuing prophylaxis for days after surgery adds side effects, Clostridioides difficile risk and resistance without reducing surgical site infection in most procedures.
The common failure is inertia: prophylaxis started in theatre and carried on by default on the ward. A stop date written at the time of prescribing is the simplest fix.
- Give prophylaxis within 60 minutes before incision, and redose for long operations or heavy blood loss.
- Write a stop time on every prophylactic antibiotic order.
- Distinguish prophylaxis from treatment of established infection, which needs a diagnosis and a course.
- Audit ward prescriptions for prophylaxis running beyond 24 hours.
Why it matters
Prolonged prophylaxis is among the largest avoidable sources of hospital antibiotic use.
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