Use of Antibiotics in Plastic Surgery

Scottsdale – Evidence-based medical practices for the appropriate use of intravenous antibiotic prophylaxis in plastic surgery are important to reduce the risk of infection. The information below is based on multiple resources including the standards developed via the Centers for Disease Control and Prevention, the Medicare National Surgical Infection Prevention Project, and various professional medical societies. These recommendations are used to reduce the risks of infection at the surgical site while reducing the risks of developing pathogens with drug resistance. In our practice, some patients may be transitioned to oral antibiotics.

Recommendation for the Use of Antibiotics at Phoenix Plastic Surgery:

Antibiotics used for prophylaxis should be carefully selected, consistent with current recommendations in the literature, and  taking into account the issues of antibiotics resistance and cosmetic surgery patient allergies.  Cefazolin is the most commonly recommended antimicrobial agent for plastic surgery operations.  Clindamycin or vancomycin may be used for patients with a confirmed ß-lactam allergy. Vancomycin may be used in patients with known colonization with methicillin resistant Staphylococcus aureus (MRSA) or in facilities with recent MRSA outbreaks. Exposure to vancomycin is a risk factor in the development of vancomycin-resistant enterococcus (VRE) colonization and infection. Therefore, vancomycin should be reserved for the treatment of serious infection with ß-lactam-resistant organisms or for treatment of infection in patients with life-threatening allergy to ß-lactam (i.e. Penicillin) antimicrobials.

Recommendation on the Timing of Antibiotics during Arizona Plastic Surgery:

Timing and dosage of antibiotic administration should optimize the efficacy of the therapy. Prophylactic antibiotics should be administered within one hour prior to skin incision. Due to an extended infusion time, vancomycin should be started within two hours prior to incision.  Dose amount should be proportional to plastic surgery patient’s weight. In patients with weight greater than 80 kg the doses of Cefazolin should be doubled.

Additional intraoperative doses (during cosmetic surgery) of antibiotic are advised when:

  • The duration of the procedure exceeds one to two times the half-life of the antibiotic used.
  • There is significant blood loss during the procedure.

General guidelines for frequency of intraoperative antibiotics are as follows:

Antibiotic Frequency of Administration
Cefazolin Every 2-5 hours
Clindamycin Every 3-6 hours
Vancomycin Every 6-12 hours

Recommendations on Stopping antibiotics after surgery:

Duration of prophylactic antibiotic administration should not exceed the 24-hour post-operative period. Prophylactic antibiotics should be discontinued within 24 hours of the end of surgery. The medical literature does not support the continuation of antibiotics until all drains or catheters are removed and provides no evidence of benefit when they are continued past 24 hours.