Surgical site infection (SSI)


Western Cape Academic Hospital Antimicrobial Recommendations
Sanford Guide
Nesibopho (Critical Care Society of SA)
Wits University


  • The need for prophylactic antibiotic therapy is based on the risk of wound contamination
  • Antibiotic prophylaxis is not required for clean operations/procedures in patients who have minimal risk of contamination. In all other situations, prophylaxis should be considered
  • Prophylaxis must be given within 60 minutes before the first incision, usually at induction
  • The prophylactic dose is a single dose equal to the standard therapeutic dose.
  • A second dose is given only if there is massive blood loss or surgery is prolonged, i.e. 2-3 hours for cefazolin OR > 8 hours for metronidazole IV.
  • Post-operative doses of prophylactic drugs are generally unnecessary.
  • Prophylactic antibiotics do not replace the need for good surgical technique and adherence to infection control measures.