Use of Prophylactic Antibiotics in Elective Breast Surgery: A Scoping Review of the Literature and Results of a UK Practice Survey

A bstract Context: There is a lack of national consensus on antibiotic prescription, choice and duration for surgical prophylaxis in elective breast surgery. Materials and Methods: A scoping review of EMBASE and MEDLINE databases was conducted to assess evidence for prophylactic antibiotics in elective breast surgery. An electronic practice survey was conducted to assess current practice in clinical settings. Results: A total of 11 published meta-analyses were found. Eight studies supported prophylactic use of antibiotics to reduce surgical site infection (SSI) in all types of breast surgery. Prolonged antibiotic use (>24 h) did not appear to have any benefit on shorter durations. There was little information on antibiotic class. A total of 50 UK and 24 international colleagues participated in the survey. International practice largely mimicked UK practice in indications for antibiotic prophylaxis, with antibiotics prescribed in the majority of implant surgeries, some cancer surgeries without implant and less often in benign surgeries. In the UK, co-amoxiclav and teicoplanin were the most commonly used antibiotics for no allergy and penicillin allergy patients, respectively, in contrast with cephalosporins internationally. There is variation nationally and internationally on the optimal duration of antibiotic prophylaxis. There was a range of additional scenarios, in which antibiotics were prescribed such as when a drain was left in situ and in ‘high-risk’ patients. Conclusion: Future work should focus on optimising duration of antibiotics in the settings of implant and breast cancer surgery. The prescriber should always document indication for antibiotics.