Current thoughts and controversies of antibiotic prophylaxis

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Abstract
Despite the widespread use of antibiotics for surgical prophylaxis, wound infections complicate at least 920,000 of the 23 million surgical procedures performed in the United States annually. Since the 1950s when early nonrandomized studies evaluating penicillin G and streptomycin in surgical prophylaxis actually showed little if any benefit and were suspected to be the cause of increasing antimicrobial resistance in hospitals, many modern randomized studies have shown perioperative prophylaxis to reduce the incidence of postoperative wound infections. Today, the practice of antimicrobial surgical prophylaxis is widespread, accepted by virtually all surgical specialists, and represents one of the most frequent uses of antibiotics in hospitals, accounting for as much as half of all antibiotics prescribed. Obviously, the clinical and financial impact of this on surgical practice is monumental and the subject of intense scrutiny by surgeons, infectious disease physicians, hospital pharmacists, administrators, and third party payers. This review will briefly summarize the principles of perioperative prophylaxis, discuss the importance of timing of administration of the antibiotic and the duration of prophylaxis, supply a cost analysis and a table of accepted referenced prophylactic antimicrobial regimens, and finally discuss special situations where surgeons believe supplemental prophylaxis is indicated.

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