For most clean and clean-contaminated procedures, antibiotic prophylaxis means a single dose given within 60 minutes before incision, repeated during surgery only for long operations or heavy blood loss. Continuing antibiotics for days after surgery, or starting them days before, does not reduce surgical site infection in most settings and adds resistance, Clostridioides difficile infection and cost.
Extended courses persist in many Indian hospitals out of habit and patient expectation. Postoperative fever or raised inflammatory markers in the first day or two are common and usually not infection.
- Give the prophylactic dose within 60 minutes before incision.
- Re-dose during surgery for long procedures or major blood loss, according to the drug's half-life.
- Stop prophylaxis at the end of surgery, or within 24 hours, unless there is a documented infection.
- Investigate postoperative fever for a source rather than extending prophylaxis by default.
Why it matters
Prolonged prophylaxis is one of the largest avoidable drivers of antibiotic use in hospitals.
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