Antibiotic Prophylaxis in Dermatologic Surgery: Advisory Statement 2025 (APDSAS 2025)

BACKGROUND: Guidelines and evidence related to antibiotic prophylaxis in dermatologic surgery have evolved since the authors' previously published advisory statement. OBJECTIVE: To provide an updated advisory statement on antibiotic prophylaxis in dermatologic surgery as guided by updated recommendations from the American Heart Association and the American Dental Association with the American Academy of Orthopaedic Surgeons guidelines. METHODS: A structured literature review was performed. A multidisciplinary team of specialists from dermatologic surgery, infectious diseases, and pharmacy were convened to review up-to-date data and develop updated comprehensive evidence-based recommendations. RESULTS: Consistent with the previous advisory statement, prophylactic antibiotics are recommended for patients with high-risk cardiac or prosthetic joint conditions, when the dermatologic surgical site is infected or if the procedure breaches the mucosa. Significant changes were made for prophylaxis of surgical site infection. Updated recommendations were made regarding antibiotic selection in penicillin-allergic patients and intraoperative use of intraincisional clindamycin in the local anesthetic. LIMITATIONS: Reviewed data are predominantly limited to retrospective data. CONCLUSION: Recommendations regarding antibiotic prophylaxis around dermatologic surgery are evolving as new data and practices are introduced. The 2025 advisory statement provides the latest recommendations for appropriate use of antibiotic prophylaxis in dermatologic surgery.