Comparative Effectiveness of Single-Dose vs. Multi-Dose Prophylactic Antibiotics in Reducing Post-Surgical...

Area of Science:

• Infectious Diseases
• Surgical Outcomes
• Pharmacology

Background:

• Surgical site infections (SSIs) are frequent, costly complications impacting patient morbidity and healthcare resources.
• Current guidelines recommend single-dose antibiotic prophylaxis, yet multi-dose regimens persist in practice, particularly for high-risk surgeries.
• The optimal antibiotic prophylaxis strategy for preventing SSIs remains a critical clinical question.

Purpose of the Study:

• To systematically compare the efficacy of single-dose versus multiple-dose prophylactic antibiotic regimens in preventing postoperative infections.
• To evaluate the impact of different antibiotic prophylaxis strategies on SSI rates and other surgical outcomes.
• To inform clinical practice and antimicrobial stewardship guidelines regarding antibiotic prophylaxis duration.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
• Comprehensive literature search across major databases (PubMed, Scopus, CENTRAL, Web of Science, ScienceDirect) up to February 2025.
• Inclusion of 47 studies comparing single- vs. multiple-dose antibiotic prophylaxis in human surgical patients, with assessment of infection-related outcomes and risk of bias.

Main Results:

• No statistically significant difference in surgical site infection (SSI) rates was found between single-dose and multiple-dose antibiotic prophylaxis groups (OR: 1.10 [95% CI: 0.87-1.39], p=0.43).
• Comparable outcomes were observed for other postoperative infections, mortality, and readmissions between the compared prophylaxis regimens.
• Moderate to high heterogeneity was noted, with most studies showing similar infection rates despite variations in antibiotic type, follow-up, and surgical setting.

Conclusions:

• Single-dose antibiotic prophylaxis demonstrates equivalent effectiveness to multiple-dose regimens in preventing postoperative infections across most surgical scenarios.
• These findings reinforce current recommendations for single-dose prophylaxis and support antimicrobial stewardship initiatives.
• Prolonged antibiotic prophylaxis should be judiciously applied only to select high-risk surgical cases, not as a routine practice.