Antibiotic Prophylaxis in Dermatologic Surgery: Updated Guidelines

Abstract

Low rates of infection associated with dermatologic surgical procedures warrant selective use of antibiotic prophylaxis. The proposed guidelines reflect current standards of practice.

Mohs Surgery for Squamous Cell Carcinoma

“…74 Data is lacking on antibiotic prophylaxis in dermatologic surgery. Guidelines by Maragh and colleagues 75 based on a review of the literature and multidisciplinary consultation suggest that antibiotic prophylaxis for prevention of surgical-site infection may be appropriate in some OTR despite the low rate of infection in dermatologic surgery. Antibiotics should not be administered for class I, or clean, wounds, based on the CDC wound classification.…”

“…Antibiotics should not be administered for class I, or clean, wounds, based on the CDC wound classification. 75,76 However, according to these investigators, prophylactic antibiotics may be administered for class II, or clean-contaminated, wounds in patients for whom a surgical-site infection would be particularly severe, and they include immunocompromised OTR in this group. 75 Technically, MMS is considered clean-contaminated because of delayed closure, but most Mohs surgeons do not administer prophylactic antibiotics.…”

“…75,76 However, according to these investigators, prophylactic antibiotics may be administered for class II, or clean-contaminated, wounds in patients for whom a surgical-site infection would be particularly severe, and they include immunocompromised OTR in this group. 75 Technically, MMS is considered clean-contaminated because of delayed closure, but most Mohs surgeons do not administer prophylactic antibiotics. 75 Occasional exceptions may be flap and graft reconstructions on the nose or ear, and procedures that have prolonged operative times.…”

“…75 Occasional exceptions may be flap and graft reconstructions on the nose or ear, and procedures that have prolonged operative times. 75 The infection rate with MMS is low and evidence is insufficient to warrant the categorical use of prophylactic antibiotics in OTR. Surgical sites that are inflamed or clearly infected require antibiotics.…”

“…75 Technically, MMS is considered clean-contaminated because of delayed closure, but most Mohs surgeons do not administer prophylactic antibiotics. 75 Occasional exceptions may be flap and graft reconstructions on the nose or ear, and procedures that have prolonged operative times. 75 The infection rate with MMS is low and evidence is insufficient to warrant the categorical use of prophylactic antibiotics in OTR.…”