Table 1 Institutional Criteria for the rational use of antibiotic prophylaxis

Indication for prophylaxis

Specific interventions of clean and clean contaminated operations where the benefit is demonstrated

Recommended drug(s) (+ Alternative drugs for patients with IgE-mediated allergy to the recommended drug(s))

Antibiotics active on bacteria presumed responsible for infections (incision site/surgical site) with the narrowest spectrum of antibacterial activity. The prophylactic regimen should cover MRSA for carriers identified before the intervention

Dose of anti-infective agent(s)

Determination of the antibacterial dose by integrating the following elements:

The individual characteristics of the patient: its weight and its rate of glomerular filtration (in renal impairment, the first dose does not require dose adjustment but the subsequent doses may need adjustment according to the results of glomerular filtration rates)

The antimicrobial specific pharmacokinetic and pharmacodynamics properties

Number of administration(s)

Determination of the number of administration(s) by integrating the following elements:

The maximum duration of prophylaxis

The patient's glomerular filtration rate (in renal impairment, the first dose does not require adjustment but the number of subsequent doses may need adjustment according to the results of glomerular filtration rates)

The half-life of the drug

The type and the duration of the intervention and the volume of blood lost during the intervention

Route of administration

Intravenous route generally. Oral route for antibiotics that reach equivalent tissue concentration when given orally

Time of administration

The most important administration is that performed before the incision. The timing of this administration depends on the infusion time (i.v route) or the absorption time (oral route) of the drug agent:

The antibiotic must be administered 15–60 min before the incision for antibiotics with rapid i.v administration (e.g. cefazolin).

Earlier administration is necessary for i.v. antibiotics which must be administered over a period of ≥ 60 min (e.g. 2 h before the incision for vancomycin) or for oral antibiotics (e.g. 2 h before the operation for ciprofloxacin tablets).

A dose will be re-administered intraoperatively (4 h after the initial dose for cefazolin) when the duration of the intervention from initiation of preoperative dose is greater than twice the half-life of the drug agent. When blood loss is significant (≥ 1.5 L), an additional dose must be re-administered intraoperatively after fluid resuscitation.

Postoperative doses are recommended for interventions specified in the guidelines, in the event of an intervention with a higher risk of postoperative infection (long, complex intervention) or if a postoperative infection would have serious consequences (implanted prosthetic material)

Duration of prophylaxis

The antibiotic prophylaxis should not exceed 24 h in total (except in heart valve replacement surgery where 48 h of prophylaxis should not be exceeded)