Effectiveness of Short Versus Traditional Antibiotic Prophylaxis in Clean Surgeries: A Nonrandomized Observational Study

Background: Surgical site infections (SSIs) remain a major concern in Indian healthcare facilities. Although worldwide recommendations prescribe single-dose antibiotic prophylaxis for clean procedures, longer regimens are nevertheless often utilized, contributing to antimicrobial resistance with no established benefit. This study investigated the efficacy of short-duration (single preoperative dosage) against typical (24–48 h) antibiotic prophylaxis in avoiding SSIs following clean surgical procedures in a tertiary care hospital. Methods: This prospective non-randomized observational comparison study was conducted over 18 months (January 2023–June 2024) at a 750-bed teaching hospital in Indore, Madhya Pradesh. A total of 384 patients undergoing elective clean operations were enrolled and assigned to either single-dose prophylaxis (a single dose of cefazolin 2 g given 30–60 min before incision, n = 192) or traditional prophylaxis (cefazolin 1 g pre-incision, followed by 1 g every 8 h for 48 h, n = 192). The primary objective was SSI at 30 days, with secondary outcomes including hospitalization, antibiotic-related side events, and cost. Results: SSI rates were comparable between groups (short: 4.7% vs. traditional: 5.2%; P = 0.82). Hospital stay was slightly shorter with short prophylaxis (3.8 ± 1.2 vs. 4.1 ± 1.4 days; P = 0.03). Antibiotic-related adverse events were significantly lower in the short-duration group (2.1% vs. 8.3%; P = 0.01), and the traditional regimen resulted in substantially higher antibiotic costs. Conclusion: Single-dose prophylaxis is as effective as extended regimens for preventing SSIs in clean surgeries while reducing adverse events, hospital stay, and costs. These findings support broader adoption of antimicrobial stewardship practices in Indian surgical care.