Antibiotic Prophylaxis for Dermatologic Surgery. Part 1: Indications, Guidelines, and Special Populations

Dermatologic surgery primarily involves clean procedures with low baseline infection rates. This 2-part continuing medical education article synthesizes current evidence to guide perioperative antibiotic decision-making for excisional dermatologic surgery, including standard excisions, Mohs micrographic surgery, and associated reconstructive techniques. Part I reviews indications for systemic prophylaxis, emphasizing a risk-stratified approach that incorporates procedural, anatomic, and patient-specific factors. Special attention is given to high-risk populations, including immunocompromised and transplant recipients, as well as the roles of topical and intra-incisional antibiotic alternatives. After completing this learning activity, participants should be able to: •Identify dermatologic surgery scenarios in which systemic antibiotic prophylaxis is indicated or not indicated, including considerations for patients with prosthetic joints, high-risk cardiac conditions, and immunosuppression. •Apply current, evidence-based guidelines to select appropriate antibiotic regimens and timing. •Evaluate the role of topical and intra-incisional antibiotics and implement strategies to minimize unnecessary use while maintaining optimal infection prevention. Patient-Facing Summary •Most skin surgeries are clean procedures with a low risk of infection. •Antibiotics are usually not needed for routine dermatologic procedures. •Certain patients, such as those with heart valve replacements, prosthetic joints, or weakened immune systems, may require antibiotics before surgery. •Using antibiotics only when necessary helps prevent side effects and antibiotic resistance. •Topical antibiotics are generally not required for clean wounds; simple ointments like petrolatum are safe and effective. •In higher-risk cases, localized intra-incisional antibiotics may be considered as an alternative to oral antibiotics.