Beta-Lactam or Not? Antibiotic Prophylaxis and Risk of Surgical-Site Infection

Clinicians occasionally prescribe clindamycin, vancomycin, or fluoroquinolones for surgical-site infection prophylaxis, typically when patients report beta-lactam allergies, but small studies suggest that these agents are less effective than beta-lactam antibiotics.

To validate these findings, researchers queried a national Swiss database and identified 350,000 adults who received antimicrobial prophylaxis for surgical procedures. Roughly 98% of patients received a beta-lactam agent (cefazolin or cefuroxime); the rest received ciprofloxacin, vancomycin, or clindamycin. About 12% received adjunctive metronidazole with or without gentamicin.