General principles for perioperative antibiotic prophylaxis

• Clean surgery (without implant) does not warrant perioperative antibiotic prophylaxis. 
• Clean-contaminated operations, or operations involving the insertion of implants, require perioperative antibiotic prophylaxis.
• Perioperative antibiotic prophylaxis is most effective when administered 0–60 minutes before the skin incision (vancomycin and fluoroquinolones: 60–120 minutes). 
• The initial dose of antibiotics should not be adjusted for renal function. 
• Redosing is required if the duration of the procedure exceeds twice the half-life of the antibiotic used.
• If an immediate-type penicillin allergy can be ruled out, a cephalosporin can be used in most cases – in place of other, less effective options.
• Surgical perioperative antibiotic prophylaxis consists of a single dose (including possible redosing). Prolonged antibiotic prophylaxis is associated with an increased risk of antimicrobial resistance and increases the risk of adverse events such as renal failure and CDI.

Swissnoso provides an exemplary guide to perioperative antibiotic prophylaxis.

Integrate the use of perioperative antibiotic prophylaxis into continuing professional development, into awareness campaigns (placing materials such as flyers, posters and checklists in relevant locations), into clinical routine and into prescription audits.