The use of antibiotics before and after plastic surgery is common, but how much is enough? Some doctors will have the patient start antibiotics several days before surgery and finish a week later. The newest trend is to give the patient a single dose of antibiotics just before the operation and then stop a day or so after surgery. Which is the better way to do things?

The basic idea is that giving antibiotics for as short a time as possible is best. The longer the patient is on antibiotics, the greater the chance of complications such as vaginal yeast infections, diarrhea, or even the serious C.Difficile infection of the colons. Furthermore, the longer the duration of the antibiotic treatment, the greater the chance of the emergence of antibiotic resistant bacteria such as MRSA that currently causes so many problems in our country.

We know from scientific studies that the antibiotic should be given about 30 minutes before surgery so that it is circulating in the bloodstream as the surgery is done and can take up residence in the tissues that are being operated upon. That way it can kill any bacteria that may be present there. As for how long the antibiotic should be continued, a number of studies suggest that it may be stopped 24 hours after surgery. A recent scientific study showed, however, that in women undergoing breast reconstruction, a single dose of antibiotic was not enough. A reasonable choice would then be to give the medication just before surgery and for 24 hours afterwards.

Some patients, however, merit longer courses of antibiotics because of health reasons. Diabetics, a patient who has just finished chemotherapy, or someone whose immune system is compromised from steroid use would fall into that category. Health care workers such as nurses or a person working in a nursing home may be carriers of MRSA and would need to be treated for a longer period of time and with different antibiotics that kill the MRSA bacteria.

The ultimate decision about duration of antibiotic therapy should be made by the patient’s plastic surgeon. To err on the side of a bit more antibiotic than a bit less would seem to be wise since an infection in an area of cosmetic surgery can negatively affect the patient’s result.

Should you have any further questions, please contact my office.

George Sanders, M.D