Update on the use of antibiotics in cutaneous surgery

Antibiotics are often prescribed in perioperative settings, including dermatologic surgery. Given the continued evolution in the breadth and complexity of cutaneous procedures performed and inevitable localized or distant infections that occasionally occur, it seems prudent to periodically evaluate findings and recommendations from the literature regarding the use of antibiotics in cutaneous surgery.

Literature review from English-language sources from the past 30 years, especially focusing on sources from the past 5 to 10 years. Data were examined for a variety of cutaneous surgical procedures, routes of antibiotic administration, and consideration of both cutaneous and distant infections.

The literature suggests that, for most routine skin procedures, antibiotic use is probably not warranted for the prevention of surgical wound infection, endocarditis, and late prosthetic joint infections. During prolonged Mohs procedures, delayed repairs, grafts, takedowns of interpolation flaps, or any procedure that breaches a mucosal surface, the evidence is less clear, and decisions should be made on a case-by-case basis. Topical antibiotics are probably overused, although silver sulfadiazine may have an undeserved negative reputation among dermatologists. Systemic prophylactic antibiotics for laser resurfacing and liposuction appear not to be routinely necessary, although patients with known prior herpes infection likely should receive antiviral prophylaxis. The overall reported infection rates and infectious complications remain low in dermatologic surgery, and antibiotic therapy may be prescribed excessively or inappropriately as a result. CONCLUSION.: Antibiotics continue to be widely used, and through varying routes of administration, in the setting of dermatologic surgery. Prudent use of these agents is indicated in high-risk patients, certain anatomic locations, and the presence of overt infection. Additional studies may help clarify the most appropriate indications, and in which patient populations, in the future.