The use of antimicrobial agents for prophylaxis in gastrointestinal, obstetric-gynecologic, cardiovascular-thoracic, orthopedic, and head-and-neck surgery is reviewed. English-language reports of studies on antimicrobial prophylaxis in surgery are reviewed. The methodology of each study was evaluated using predetermined criteria, and "evaluable" regimens are included in this review. For each type of surgical procedure, the discussion covers normal infection rates, probable bacterial contaminants, evaluable studies, and specific treatment recommendations. Regimens found to be evaluable numbered 76, with 72 of these showing a decreased infection rate with antibiotics versus placebo. Statistically significant decreases were found in 57 regimens. When properly used, antimicrobial agents have experimental justification for use in some surgical procedures. Factors that should be considered in the risk-benefit equation include: potential for and significance of surgical infection; cost, adverse effects, and ease of administration of antimicrobial agents; development of resistant microorganisms and of superinfection; and improper reliance on antimicrobial agents with resulting disregard for aseptic technique.

 

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