Prophylactic antibiotics in obstetric and gynaecological surgery

The patient is anaesthetised and the knife is being handed over. “Have antibiotics gone in?” is not clerical small talk. At incision, prophylaxis is either already in the tissues or it has missed its main opportunity.^[1][10]

Definition and wound classification

Surgical antimicrobial prophylaxis is a short perioperative course given before microbial inoculation to reduce surgical-site infection (SSI). It is not treatment for established infection and it does not compensate for asepsis, gentle tissue handling, haemostasis or source control.^[1][10]

SSIs are described as superficial incisional, deep incisional and organ-space. After hysterectomy, organ-space infection includes pelvic abscess or infected vaginal cuff collections.^[2][3]

References12ShowHide

1. [1]Van Eyk N, van Schalkwyk J No. 275-Antibiotic Prophylaxis in Gynaecologic Procedures J Obstet Gynaecol Can, 2018.PMID 30390951
2. [2]Ayeleke RO, Mourad S, Marjoribanks J, Calis KA Antibiotic prophylaxis for elective hysterectomy Cochrane Database Syst Rev, 2017.PMID 28625021
3. [3]Pop-Vicas A, Johnson S, Safdar N Cefazolin as surgical antimicrobial prophylaxis in hysterectomy: A systematic review and meta-analysis of randomized controlled trials Int J Antimicrob Agents, 2019.PMID 30516122
4. [4]Song N, Gao M, Tian J, Gao Y Choice for prophylactic antibiotics: Cefazolin plus metronidazole or cefoxitin alone for endometrial cancer surgical staging J Obstet Gynaecol Res, 2020.PMID 32558128
5. [5]Phoolcharoen N, Nilgate S, Rattanapuntamanee O, et al. A randomized controlled trial comparing ceftriaxone with cefazolin for antibiotic prophylaxis in abdominal hysterectomy Int J Gynaecol Obstet, 2012.PMID 22789440
6. [6]Akkour KM, Arafah MA, Alhulwah MM A comparative study between a single-dose and 24-hour multiple-dose antibiotic prophylaxis for elective hysterectomy J Infect Public Health, 2020.PMID 33296344
7. [7]Morrill MY, Schimpf MO, Abed H, et al. Antibiotic prophylaxis for selected gynecologic surgeries Int J Gynaecol Obstet, 2013.PMID 23040720
8. [8]Van Eyk N, van Schalkwyk J Antibiotic prophylaxis in gynaecologic procedures J Obstet Gynaecol Can, 2012.PMID 22472341
9. [9]Smaill F, Hofmeyr GJ Antibiotic prophylaxis for cesarean section Cochrane Database Syst Rev, 2002.PMID 12137614
10. [10]Classen DC, Evans RS, Pestotnik SL, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection N Engl J Med, 1992.PMID 1728731
11. [11]Choi WS, Song JY, Hwang JH, et al. Appropriateness of antibiotic prophylaxis for major surgery in Korea Infect Control Hosp Epidemiol, 2007.PMID 17620250
12. [12]Jackson MM, Eckhardt LR, Zamani M, Watson N Metronidazole Plus Cefazolin Compared with Cefazolin Alone for Surgical Site Infection Prophylaxis in Patients Undergoing Hysterectomy: A Systematic Review Obstet Gynecol, 2026.PMID 41547385