European Journal of Plastic Surgery

, Volume 42, Issue 5, pp 481–488 | Cite as

Antibiotic prophylaxis: current recommendations in plastic surgery

  • Shana S. Kalaria
  • Thanapoom Boonipat
  • J. Michael Smith
  • Eric L. ColeEmail author
Original Paper



Guidelines for prophylactic antibiotics in surgery have long been established; however, few have focused on recommendations in plastic surgery. Surgical site infection rates remain low, yet the use of prophylactic antibiotics has surged in the past 30 years. This article summarizes current recommendations of prophylactic antibiotic use to produce consensus guidelines in plastic surgery.


A literature review was conducted in the PubMed, Cochrane, and Ovid databases and studies were included if randomized controlled trials indicated a statistically significant decrease in surgical site infections. Surveys conducted by the American Society of Plastic Surgeons regarding prophylactic antibiotic use from 1975, 1985, 2000, and 2010 were compiled and analyzed.


Of 143 articles found, nine randomized controlled trials showed a reduction in surgical site infections after antibiotic prophylaxis for specific plastic surgery procedures. There are evidence-based recommendations for prophylactic antibiotics in breast surgery, abdominoplasty, contaminated hand or face surgery, prosthetic surgery, rhinoplasty, microsurgery, and acute and burn reconstruction cases. The proportion of plastic surgeons using prophylactic antibiotics has steadily increased from 1975 to 2010 with a significant increase from 2000 to 2010.


Systemic antibiotic prophylaxis is recommended for use in breast surgery, abdominoplasty, contaminated hand or face surgery, prosthetic surgery, rhinoplasty, microsurgery, and acute and burn reconstruction cases. Recent surveys indicate that the majority of plastic surgeons continue to use prophylactic antibiotics in clean cases of the hand, face, and body despite recommendations. Additional procedure-specific randomized controlled trials are necessary to provide evidence-based recommendations for antibiotic prophylaxis in plastic surgery.

Level of Evidence: Level IV, risk / prognostic study


Antibiotic prophylaxis Antibiotic guidelines Antibiotics plastic surgery 


Compliance with ethical standards

Conflict of interest

Shana S. Kalaria, Thanapoom Boonipat, J. Michael Smith, and Eric L. Cole declare that they have no conflict of interest.

Ethical approval

For this type of study formal consent is not required.

Funding source

This work received neither financial support nor funding.


  1. 1.
    No authors listed (2012) Antimicrobial prophylaxis for surgery. Treat Guidel Med Lett 10:73–78 quiz 79–80Google Scholar
  2. 2.
    Gravante G, Caruso R, Araco A, Cervelli V (2008) Infections after plastic procedures: incidences, etiologies, risk factors, and antibiotic prophylaxis. Aesthetic Plast Surg 32:243–251Google Scholar
  3. 3.
    Hsu P, Bullocks J, Matthews M (2006) Infection prophylaxis update. Semin Plast Surg 20:241–248CrossRefGoogle Scholar
  4. 4.
    Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA, American Society of Health-System P, Infectious Diseases Society of A, Surgical Infection S, Society for Healthcare Epidemiology of A (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect 14:73–156CrossRefGoogle Scholar
  5. 5.
    Parikh RP, Nguyen DC, Skolnick GB, Patel KB, Woo AS (2015) Surgical site infections in pediatric plastic surgery: risk factors and implications for quality improvement from a nationwide assessment of 11,656 operations. Plast Reconstr Surg 136:120CrossRefGoogle Scholar
  6. 6.
    Porco TC, Gao D, Scott JC, Shim E, Enanoria WT, Galvani AP, Lietman TM (2012) When does overuse of antibiotics become a tragedy of the commons? PLoS One 7:e46505CrossRefGoogle Scholar
  7. 7.
    Hall AJ, Curns AT, McDonald LC, Parashar UD, Lopman BA (2012) The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999-2007. Clin Infect Dis 55:216–223CrossRefGoogle Scholar
  8. 8.
    Hansen D, Pollan LD, Fernando H (2013) Fulminant Clostridium difficile colitis: a complication of perioperative antibiotic prophylaxis. J Oral Maxillofac Surg 71:1880–1885CrossRefGoogle Scholar
  9. 9.
    Landes G, Harris PG, Lemaine V, Perreault I, Sampalis JS, Brutus JP, Lessard L, Dionyssopoulos A, Nikolis A (2008) Prevention of surgical site infection and appropriateness of antibiotic prescribing habits in plastic surgery. J Plast Reconstr Aesthet Surg 61:1347–1356CrossRefGoogle Scholar
  10. 10.
    Li GH, Hou DJ, Fu HD, Guo JY, Guo XB, Gong H (2014) A review of prophylactic antibiotics use in plastic surgery in China and a systematic review. Int J Surg 12:1300–1305CrossRefGoogle Scholar
  11. 11.
    Garner JS (1986) CDC guideline for prevention of surgical wound infections, 1985. Supersedes guideline for prevention of surgical wound infections published in 1982. (Originally published in November 1985). Revised. Infect Control 7:193–200CrossRefGoogle Scholar
  12. 12.
    Simmons BP (1982) Guideline for prevention of surgical wound infections. Infect Control 3:185–196Google Scholar
  13. 13.
    Krizek TJ, Gottlieb LJ, Koss N, Robson MC (1985) The use of prophylactic antibacterials in plastic surgery: a 1980s update. Plast Reconstr Surg 76:953–963CrossRefGoogle Scholar
  14. 14.
    Krizek TJ, Koss N, Robson MC (1975) The current use of prophylactic antibiotics in plastic and reconstructive surgery. Plast Reconstr Surg 55:21–32CrossRefGoogle Scholar
  15. 15.
    Lyle WG, Outlaw K, Krizek TJ, Koss N, Payne WG, Robson MC (2003) Prophylactic antibiotics in plastic surgery: trends of use over 25 years of an evolving specialty. Aesthet Surg J 23:177–183CrossRefGoogle Scholar
  16. 16.
    Elward AM, McAndrews JM, Young VL (2009) Methicillin-sensitive and methicillin-resistant Staphylococcus aureus: preventing surgical site infections following plastic surgery. Aesthet Surg J 29:232–244CrossRefGoogle Scholar
  17. 17.
    Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, Fridkin SK, National Healthcare Safety Network T, Participating National Healthcare Safety Network F (2008) NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 29:996–1011CrossRefGoogle Scholar
  18. 18.
    Yoo DB, Peng GL, Azizzadeh B, Nassif PS (2015) Microbiology and antibiotic prophylaxis in rhinoplasty: a review of 363 consecutive cases. JAMA Facial Plast Surg 17:23–27CrossRefGoogle Scholar
  19. 19.
    Perrotti JA, Castor SA, Perez PC, Zins JE (2002) Antibiotic use in aesthetic surgery: a national survey and literature review. Plast Reconstr Surg 109:1685–1695CrossRefGoogle Scholar
  20. 20.
    Ariyan S, Martin J, Lal A, Cheng D, Borah GL, Chung KC, Conly J, Havlik R, Lee WP, McGrath MH, Pribaz J, Young VL (2015) Antibiotic prophylaxis for preventing surgical-site infection in plastic surgery: an evidence-based consensus conference statement from the American Association of Plastic Surgeons. Plast Reconstr Surg 135:1723–1739CrossRefGoogle Scholar
  21. 21.
    Hardwicke JT, Bechar J, Skillman JM (2013) Are systemic antibiotics indicated in aesthetic breast surgery? A systematic review of the literature. Plast Reconstr Surg 131:1395–1403CrossRefGoogle Scholar
  22. 22.
    Shortt R, Cooper MJ, Farrokhyar F, Bain J (2014) Meta-analysis of antibiotic prophylaxis in breast reduction surgery. Plast Surg (Oakv) 22:91–94CrossRefGoogle Scholar
  23. 23.
    Amland PF, Andenaes K, Samdal F, Lingaas E, Sandsmark M, Abyholm F, Giercksky KE (1995) A prospective, double-blind, placebo-controlled trial of a single dose of azithromycin on postoperative wound infections in plastic surgery. Plast Reconstr Surg 96:1378–1383CrossRefGoogle Scholar
  24. 24.
    Khan UD (2010) Breast augmentation, antibiotic prophylaxis, and infection: comparative analysis of 1,628 primary augmentation mammoplasties assessing the role and efficacy of antibiotics prophylaxis duration. Aesthetic Plast Surg 34:42–47Google Scholar
  25. 25.
    Sevin A, Senen D, Sevin K, Erdogan B, Orhan E (2007) Antibiotic use in abdominoplasty: prospective analysis of 207 cases. J Plast Reconstr Aesthet Surg 60:379–382CrossRefGoogle Scholar
  26. 26.
    Toia F, D’Arpa S, Massenti MF, Amodio E, Pirrello R, Moschella F (2012) Perioperative antibiotic prophylaxis in plastic surgery: a prospective study of 1,100 adult patients. J Plast Reconstr Aesthet Surg 65:601–609CrossRefGoogle Scholar
  27. 27.
    Alexander JW, MacMillan BG, Law EJ, Krummel R (1982) Prophylactic antibiotics as an adjunct for skin grafting in clean reconstructive surgery following burn injury. J Trauma 22:687–690CrossRefGoogle Scholar
  28. 28.
    Avni T, Levcovich A, Ad-El DD, Leibovici L, Paul M (2010) Prophylactic antibiotics for burns patients: systematic review and meta-analysis. BMJ 340:c241CrossRefGoogle Scholar
  29. 29.
    Baran CN, Sensoz O, Ulusoy MG (1999) Prophylactic antibiotics in plastic and reconstructive surgery. Plast Reconstr Surg 103:1561–1566CrossRefGoogle Scholar
  30. 30.
    Hauck RM, Nogan S (2013) The use of prophylactic antibiotics in plastic surgery: update in 2010. Ann Plast Surg 70:91–97CrossRefGoogle Scholar
  31. 31.
    Aydin N, Uraloglu M, Yilmaz Burhanoglu AD, Sensoz O (2010) A prospective trial on the use of antibiotics in hand surgery. Plast Reconstr Surg 126:1617–1623CrossRefGoogle Scholar
  32. 32.
    Bykowski MR, Sivak WN, Cray J, Buterbaugh G, Imbriglia JE, Lee WP (2011) Assessing the impact of antibiotic prophylaxis in outpatient elective hand surgery: a single-center, retrospective review of 8,850 cases. J Hand Surg Am 36:1741–1747CrossRefGoogle Scholar
  33. 33.
    Mundinger GS, Borsuk DE, Okhah Z, Christy MR, Bojovic B, Dorafshar AH, Rodriguez ED (2015) Antibiotics and facial fractures: evidence-based recommendations compared with experience-based practice. Craniomaxillofac Trauma Reconstr 8:64–78CrossRefGoogle Scholar
  34. 34.
    Gonzalez-Castro J, Lighthall JG (2016) Antibiotic use in facial plastic surgery. Facial Plast Surg Clin North Am 24:347–356CrossRefGoogle Scholar
  35. 35.
    Casaer B, Tan EK, Depoorter M (2009) The role of antibiotic prophylaxis in abdominoplasty: a review of the infection rate in 300 cases treated without prophylaxis. Plast Reconstr Surg 123:42eCrossRefGoogle Scholar
  36. 36.
    Chaouat M, Levan P, Lalanne B, Buisson T, Nicolau P, Mimoun M (2000) Abdominal dermolipectomies: early postoperative complications and long-term unfavorable results. Plast Reconstr Surg 106:1614–1623CrossRefGoogle Scholar
  37. 37.
    Baker KA (2000) Antibiotic prophylaxis for selected implants and devices. J Calif Dent Assoc 28:620–626Google Scholar
  38. 38.
    Friedlander AH (2009) Presence of staphylococci in mouth and presence of streptococci in late infections of knee and hip joint prostheses: antibiotic prophylaxis, a conundrum. Spec Care Dentist 29:226–228CrossRefGoogle Scholar
  39. 39.
    Lockhart PB, Garvin KL, Osmon DR, Hewlett AL, Scuderi G, Lewallen D, Vail T (2013) The antibiotic prophylaxis guideline for prosthetic joints: trying to do the right thing. J Am Acad Orthop Surg 21:193–194Google Scholar
  40. 40.
    Marculescu CE, Osmon DR (2005) Antibiotic prophylaxis in orthopedic prosthetic surgery. Infect Dis Clin N Am 19:931–946CrossRefGoogle Scholar
  41. 41.
    Skaar DD, Park T, Swiontkowski MF, Kuntz KM (2015) Cost-effectiveness of antibiotic prophylaxis for dental patients with prosthetic joints: comparisons of antibiotic regimens for patients with total hip arthroplasty. J Am Dent Assoc 146:830–839CrossRefGoogle Scholar
  42. 42.
    Huang N, Liu M, Yu P, Wu J (2015) Antibiotic prophylaxis in prosthesis-based mammoplasty: a systematic review. Int J Surg 15:31–37CrossRefGoogle Scholar
  43. 43.
    Clayton JL, Bazakas A, Lee CN, Hultman CS, Halvorson EG (2012) Once is not enough: withholding postoperative prophylactic antibiotics in prosthetic breast reconstruction is associated with an increased risk of infection. Plast Reconstr Surg 130:495–502CrossRefGoogle Scholar
  44. 44.
    Townley WA, Baluch N, Bagher S, Maass SW, O’Neill A, Zhong T, Hofer SO (2015) A single pre-operative antibiotic dose is as effective as continued antibiotic prophylaxis in implant-based breast reconstruction: a matched cohort study. J Plast Reconstr Aesthet Surg 68:673–678CrossRefGoogle Scholar
  45. 45.
    Krasny M, Krasny K, Zadurska M, Fiedor P (2016) Evaluation of treatment outcomes and clinical indications for antibiotic prophylaxis in patients undergoing implantation procedures. Adv Med Sci 61:113–116CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Plastic Surgery, Department of SurgeryUniversity of Texas Medical BranchGalvestonUSA
  2. 2.Geisel School of Medicine at DartmouthHanoverUSA

Personalised recommendations