The use of antimicrobial therapy in the field of cutaneous surgery can be a difficult and controversial topic. Overall, there are a lack of randomized controlled clinical trials evaluating the efficacy of antimicrobial prophylaxis within our field. As a result, much of the recommendations for antimicrobial prophylaxis are extrapolated from other fields, such as dentistry, cardiology, and orthopedics. We continue our Surgical Therapeutic Cheat Sheet Series with an algorithmic approach adopted from Strickler et al.’s 2021 Journal of the American Academy of Dermatology Continuing Medical Education article.
Further Reading
If you want to learn more about antibiotic prophylaxis in cutaneous surgery, check out the following article recently published in the Journal of Drugs in Dermatology:
Antibiotic Practices in Mohs Micrographic Surgery
Background: Mohs micrographic surgery is a safe procedure with low rates of infection.
Objective: To establish current antibiotic prescribing practices amongst Mohs surgeons.
Methods and Materials: 16-question survey sent to American College of Mohs Surgery members.
Results: 305 respondents with collectively 7,634+ years of experience. The majority performed outpatient surgery (95.0%) and avoided oral or topical antibiotics for routine cases (67.7% and 62.8%, respectively). Prophylactic antibiotics were routinely prescribed for artificial cardiac valves (69.4%), anogenital surgery (53.0%), wedge excision (42.2%), artificial joints (41.0%), extensive inflammatory skin disease (40.1%), immunosuppression (38.9%), skin grafts (36.4%), leg surgery (34.2%), and nasal flaps (30.1%). A minority consistently swabbed the nares to check for staphylococcus aureus carriage (26.7%) and decolonized carriers prior to surgery (28.0%).
Conclusion: Disparity exists in antibiotic prescribing practices amongst Mohs surgeons. There may be under-prescription of antibiotics for high risk factors like nasal flaps, wedge excisions, skin grafts, anogenital/lower extremity site, and extensive inflammatory disease. Conversely, there may be over-prescription for prosthetic joints or cardiac valves. Increased guideline awareness may reduce post-operative infections and costs/side effects from antibiotic over-prescription.
J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.4695
References:
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- Strickler AG, Shah P, Bajaj S, et al. Preventing complications in dermatologic surgery: Presurgical concerns [published correction appears in J Am Acad Dermatol. 2021 Aug;85(2):535]. J Am Acad Dermatol. 2021;84(4):883-892.
- Wright TI, Baddour LM, Berbari EF, et al. Antibiotic prophylaxis in dermatologic surgery: advisory statement 2008. J Am Acad Dermatol. 2008;59(3):464-473.
- Harlan CA; Nguyen NB, Hirshburg JM. Updates on Recommendations for Prophylactic Antibiotics in Dermatologic Surgery. Derm Surg. 2021;47(2):298-300.
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