Impact of Penicillin Allergy on Antibiotic Prophylaxis Selection and Surgical Site Infection Rates in Plastic Surgery: A Systematic Review

<b><i>Background:</i></b> Patients undergoing plastic and reconstructive procedures with penicillin allergies (PAs) often receive second-line antibiotic agents. Evidence from other surgical specialties suggests this can lead to increased complications and greater morbidity. However, limited research exists in plastic surgery regarding this issue. This systematic review consolidates existing literature on the impact of PAs and alternative antibiotic agent use in plastic surgery, highlighting findings and future research directions. <b><i>Methods:</i></b> A systematic search of SCOPUS, PubMed (including MEDLINE), EMBASE, and the Cochrane Library was conducted on January 7, 2025, to identify studies evaluating the effects of PAs or second-line antibiotic agents on plastic surgery outcomes. Studies were included if full-text English articles were available. Five studies, comprising 2,318 patients, met the inclusion criteria. <b><i>Results:</i></b> Of the five studies included, two focused on head and neck procedures, one on general plastic surgery, and two on abdominal wall reconstruction. Four studies compared first-line versus second-line antibiotic agents, reporting higher infection and complication rates with second-line agents. No allergic reactions were reported. One study evaluated the implementation of a PA protocol, demonstrating increased first-line antibiotic agent adherence and a reduction in complication rates. <b><i>Conclusion:</i></b> Research on the impact of PAs in plastic and reconstructive surgery is limited. However, existing evidence aligns with findings from other surgical fields, suggesting that patients receiving second-line antibiotic agents experience worse outcomes. Further research is needed to optimize prophylactic antibiotic agent selection in patients with PAs undergoing a plastic surgery.