Optimizing Antibiotic Prophylaxis Strategies: Single Dose Versus Multiple Dose Antibiotics in Clean Surgical Procedures

Abstract

Background: Surgical site infections (SSI) remain an important cause of morbidity after clean surgical procedures. Prolonged use of antibiotic prophylaxis is common practice, despite guideline recommendations supporting single-dose regimens. This study aimed to compare the efficacy of single-dose versus multiple-dose antibiotic prophylaxis in clean surgical procedures.

Methods: A prospective comparative study was conducted at a tertiary care hospital over 10 months. Fifty patients undergoing elective ventral hernia repair were randomized into two groups: Group A (25 patients, onlay meshplasty with multiple-dose prophylaxis) and Group B (25 patients, sublay meshplasty with single-dose prophylaxis). Data on surgical duration, surgical site infections, postoperative complications (seroma, wound infection, flap necrosis), hospital stay, and cost-effectiveness were analyzed using appropriate statistical tests.

Results: The mean duration of surgery was similar in both groups (101.6 ± 37.8 min vs. 97.2 ± 30.3 min; p=0.652). Overall complication rates were significantly higher in the onlay group (36.0%) compared to the sublay group (8.0%; p=0.014). SSI occurred in 16.0% of onlay versus 4.0% of sublay patients (p=0.157). Seroma formation (20.0% vs. 4.0%) and flap necrosis (16.0% vs. 0%) were more common in the onlay group, with flap necrosis showing statistical significance (p=0.037). The average hospital stay was longer in the onlay group (4.88 ± 1.30 days) compared to the sublay group (3.84 ± 0.99 days; p=0.003). Cost-effectiveness favored single-dose prophylaxis due to reduced antibiotic usage and shorter hospitalization.

Conclusion: Single-dose antibiotic prophylaxis is effective, safe, and cost-efficient for clean surgical procedures. When combined with sublay meshplasty, it provides superior outcomes compared to onlay repair with multiple-dose prophylaxis. Adoption of single-dose strategies in line with global guidelines can reduce unnecessary antibiotic exposure and associated complications while maintaining patient safety.