Perioperative Antibiotic Prophylaxis

Clinical Objective

Administer systemic antibiotic prophylaxis at the correct time, dose, and duration to reduce SSI risk in appropriate surgical cases, while avoiding unnecessary antibiotic use that contributes to antimicrobial resistance. Prophylaxis is not a substitute for good surgical technique.

Protocol Steps

1. 1

   Assess the wound classification (clean, clean-contaminated, contaminated, dirty) to determine whether prophylaxis is indicated.

2. 2

   For clean procedures under 60 minutes in low-risk patients, prophylaxis may not be indicated — review evidence-based guidelines.

3. 3

   Select agent based on the expected flora: cefazolin is the standard first-line agent for most veterinary surgical procedures.

4. 4

   Administer IV cefazolin at 22 mg/kg 30–60 minutes before incision.

5. 5

   Confirm administration time is recorded before the patient enters the OR.

6. 6

   For procedures lasting >90 minutes, administer a redosing interval of cefazolin (every 90–120 minutes intraoperatively).

7. 7

   Discontinue prophylaxis within 24 hours of surgery — prolonged courses do not reduce SSI and increase resistance risk.

Key Pitfalls to Avoid

• Administering antibiotics more than 60 minutes before incision — peak tissue levels do not coincide with the wound.

• Continuing prophylactic antibiotics for multiple days 'just in case' — this is therapeutic dosing without a diagnosis.

• Using broad-spectrum agents (amoxicillin-clavulanate, fluoroquinolones) as first-line prophylaxis without indication.

• Omitting intraoperative redosing in long procedures, particularly orthopedic cases.