1Professor, Department of General Surgery, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Tamil Nadu, India
2Final Year MBBS Student, Gandhi Medical College, Musheerabad, Hyderabad – 500003, Telangana, India
3*Postgraduate, Department of General Surgery, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Tamil Nadu, India
Email: surgicalcare@gmail.com
4Final Year MBBS Student, Gandhi Medical College, Musheerabad, Hyderabad – 500003, Telangana, India
5Department of General Surgery, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Tamil Nadu, India
Background: Surgical antimicrobial prophylaxis (SAP) is a cornerstone of surgical site infection (SSI) prevention and a critical determinant of safe surgical care. However, inappropriate prophylactic antibiotic use—particularly prolonged postoperative administration and unnecessary broad-spectrum coverage—has been increasingly implicated in the emergence and spread of antimicrobial resistance (AMR). In the context of escalating resistance and persistent variability in perioperative prescribing practices, there is a pressing need to re-evaluate SAP through a comprehensive antimicrobial stewardship framework.
Methods: This narrative review synthesizes contemporary evidence on SAP and antimicrobial stewardship. Authoritative textbooks, national and international guidelines, randomized controlled trials, observational studies, and stewardship intervention reports published between 2021 and 2025 were reviewed. Emphasis was placed on formal definitions, pharmacological standards, real-world practice patterns, dosing and duration of prophylaxis, and stewardship-oriented interventions relevant to both global and Indian surgical settings.
Results: The reviewed evidence consistently demonstrates that prolonged postoperative prophylaxis and routine escalation to broad-spectrum agents do not reduce SSI rates in clean and clean-contaminated surgeries. Single-dose or short-duration prophylaxis using standard agents—most commonly cefazolin 2 g intravenously administered within 60 minutes prior to incision—was effective across surgical specialties, including orthopedic, obstetric, and abdominal surgery. Indian studies revealed widespread non-adherence to guideline-recommended duration despite appropriate per-dose quantities, with prolonged prophylaxis contributing to increased antimicrobial exposure and healthcare costs without clinical benefit. Antimicrobial stewardship interventions, including audit-and-feedback mechanisms and multidisciplinary stewardship teams, consistently improved compliance with SAP standards. National and international guidelines demonstrated strong concordance in recommending stewardship-aligned SAP principles.
Conclusion: Inappropriate SAP is a modifiable and preventable driver of antimicrobial resistance. The cumulative evidence supports stewardship-aligned prophylaxis characterized by correct agent selection, standardized dosing, precise peri-incisional timing, and minimal effective duration. Integrating antimicrobial stewardship into routine surgical workflows is essential to optimize patient outcomes, reduce resistance pressure, and preserve the long-term safety and sustainability of surgical care in the era of antimicrobial resistance.
MeSH Keywords: Antimicrobial Stewardship; Surgical Site Infection; Antibiotic Prophylaxis; Drug Resistance, Microbial; Infection Control; Surgery.
How to cite this article: Eswar CM, Chebolu SVR, Kumar NA, Akula HR, Vijayakumar H. Surgery in the Era of Antibiotic Resistance: Rethinking Prophylaxis and Stewardship — A Concise Narrative Review. Int J Drug Deliv Technol. 2026;16(6s): 855-865; DOI: 10.25258/ijddt.16.6s.113
Source of support: None
Conflict of interest: None