Current guidelines for antibiotic prophylaxis of surgical wounds.

Appropriately administered antibiotic prophylaxis reduces the incidence of surgical wound infection. Prophylaxis is uniformly recommended for all clean-contaminated, contaminated and dirty procedures. It is considered optional for most clean procedures, although it may be indicated for certain patients and clean procedures that fulfill specific risk criteria. Timing of antibiotic administration is critical to efficacy. The first dose should always be given before the procedure, preferably within 30 minutes before incision. Readministration at one to two half-lives of the antibiotic is recommended for the duration of the procedure. In general, postoperative administration is not recommended. Antibiotic selection is influenced by the organism most commonly causing wound infection in the specific procedure and by the relative costs of available agents. In certain gastrointestinal procedures, oral and intravenous administration of agents with activity against gram-negative and anaerobic bacteria is warranted, as well as mechanical preparation of the bowel. Cefazolin provides adequate coverage for most other types of procedures.