Current opinions on the use of prophylactic antibiotics in patients undergoing laparoscopic cholecystectomy.

Abstract

Inappropriate use of antibiotics leads to microbial resistance. Single-dose antibiotic prophylaxis prior to laparoscopic cholecystectomy is well known for reducing the risk of postoperative infection in high-risk patients despite some conflicting aspects. High-risk patients are those who are older than 70 years, have diabetes mellitus, whose operation time exceeded 120 minutes, have acute cholecystitis, experienced iatrogenic intraoperative gallbladder perforation resulting in bile or gallstone spillage, suffered from obstructive jaundice, or were deemed immunocompromised. For gallbladder perforation, one dose of antibiotic prophylaxis is sufficient. Therefore, guidelines are needed and must be strictly followed. Prophylactic treatment is not needed for patients at low risk of developing sepsis following elective laparoscopic cholecystectomy, although the opposite is supported. Similarly, superficial surgical infections are related to low morbidity. Patients without risk factors have a very low risk of infection. Thus, the routine use of antibiotic prophylaxis in elective laparoscopic cholecystectomy is not recommended.