A comparative study on antibiotics and no antibiotics in clean surgical cases


  • Praveen Gudde Prasanna Department of Surgery, A J Institute of Medical Sciences, Mangalore, Karnataka, India
  • Harindranath Ranganath Department of Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India




Clean surgical cases, Prophylactic antibiotic, Post-operative wound infection


Background: Surgical wound infection is one of the most commonly occurring complications and its incidence has been lowest in clean surgical cases. Prophylactic antibiotics are routinely used in all surgical cases. But this is not indicated in clean surgical cases. Due to undue fear of infections, many practicing surgeons use antibiotics in clean surgical cases. Misuse of antimicrobials leads to drug toxicity, super infections, high health care cost and colonization of wards by highly resistant microbes. Objective of the study is to compare the frequencies of wound site infections in patients undergoing clean elective general surgery operations with no antibiotics and single dose prophylactic antibiotics.

Methods: A comparative study of 100 patients undergoing elective clean surgeries at Victoria Hospital from November 2012 to October 2014 was undertaken. Data was collected by history taking, clinical examination, hematological and microbiological investigations and follow up.

Results: Two cases in each group had post-operative infections noticed on the day 2 wound examination. All the four cases had culture positive with isolates being S. aureus in three and E. coli in single case.

Conclusions: Post-operative wound infections noted in two cases in both the groups do not have any clinical and statistical significance; hence single dose of prophylactic antibiotics is not required in all the clean surgical cases. A simple size of large number is required in this area of research to conclude with statistical significance.

Author Biographies

Praveen Gudde Prasanna, Department of Surgery, A J Institute of Medical Sciences, Mangalore, Karnataka, India

Assistant professor, Dept of General Surgery

Harindranath Ranganath, Department of Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India

Professor, Dept of General Surgery


Williams NS. Surgical infections In: Norman S Williams, Christopher J K Bulstrode, P. Ronan O’Connell, eds. Bailey and Love’s, Short Practice of Surgery, 25th ed, London, United Kingdom: Hodder Arnold; 2008: 32-33.

Cuschieri SA, Steele RJ. Patients with postoperative complications. In: Cuschieri SA, Steele RJ, Moosa AR Eds. Essential surgical practice. 4th Ed. Oxford: Butterworth - Heinemann; 2000: 422-423.

Bhatti HA, Shahid A, Ahmad I, Qureshi AI. Role of antibiotic prophylaxis in clean surgery. Pakistan Postgrad. Med J. 2000;11(3):87-8.

Delinger EP. Surgical infections and choice of antibiotics. In: Townsend C. M., Beauchamp RD, Evers BM, Mattox K., Eds. Sabiston textbook of surgery. 18th ed. Philadelphia: W. B. Saunders Company; 2001: 171-176.

Nandi PL, Rajan SS, Mak KC, Chan SC, So YP. Surgical wound infection. Hong Kong Med J. 1999;5:82-6.

Sabir S. Clinical audit of antibiotic use and infection rate in a plastic surgery unit. J Coll Phy Surg Pakistan. 2001;11:103-6.

Akhtar S, Ali A, Farhan K, Nadeem A, Gondal KM, Majeed C. Duration of surgery: does it contribute to postoperative wound infection. Pak J Surg. 2001;17:35-40.

Leaper DJ. Wound infection. In: Russell RC, Williams NS, Bulstrode CJ Eds. Bailey and Love’s short practice of surgery. 23rd ed. London: Arnold; 2000: 87-98.

Sanchez‐Manuel FJ, Lozano‐García J, Seco‐Gil JL. Antibiotic prophylaxis for hernia repair. Cochrane Database Sys Rev. 2012(2).

Sohil Ahmed K. Survey and evaluation of antibiotic prophylaxis usage in surgery wards of tertiary level institution before and after the implementation of clinical guidelines. Ind J Surg. 2006;68(3):150-6.

Sabovcík R, Kyslan K. Prophylactic antibiotics in plastic surgery. Rozhl Chir. 2006 Jun;85(6):299-301.

Munckhof W. Antibiotics for surgical prophylaxis. Austral Prescrib. 2005;28(2):38-40.

Rehan HS, Kakkar AK, Goel S. Pattern of surgical antibiotic prophylaxis in a tertiary care teaching hospital in India. Int J Inf Cont. 2010;6(2):2-6.

Knight R, Charbonneau P, Ratzer E, Zeren F, Haun W, Clark J. Prophylactic antibiotics are not indicated in clean general surgery cases. Am J Surg. 2001;182(6):682-6.

Solangi RA, Memon GA, Dahri FJ, Qazi AR, Yousifan SA. Does every clean surgical wound need antimicrobials. Med Channel. 2004;10(3):41-3.

NICE Clinical Guidelines (NG 125); National Institute for Health and Clinical Excellence; Surgical site infection Prevention and treatment of surgical site infection; issue date April 2019: Available at; https://www.nice.org.uk/guidance/ng125/chapter/Recommendations #1.2.13. Accessed on Oct 2019.

Simons MP, Aufenacker T, Bay-Neilson M, Bouillot JL, Campanelli G, Conze J, European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343-403.

Ansari SA, Saddique M, Azim WA. Antibiotic prophylaxis in clean surgery. Biomedica. 2005;21:121-4.






Original Research Articles