Multiple-dose antibiotic not recommended for preventing infection after breast reconstruction

The use of multiple-dose antibiotic to prevent surgical site infection (SSI) and implant removal following implant-based breast reconstruction does not appear to be more effective than a single-dose regimen, as shown in a study. In addition, the multi-dose regimen increases the risk of adverse events associated with antibiotic treatment.

A total of 698 women who were scheduled to undergo immediate or delayed implant-based breast reconstruction were randomized to receive multiple-dose intravenous antibiotic prophylaxis (n=353), extending over 24 hours following surgery or single-dose intravenous antibiotic (n=345). The first-choice drug was cloxacillin (2 g per dose), while clindamycin was given (600 mg per dose) to patients with penicillin allergy. The total follow-up time was 12 months.

The median age was 47 years in the multiple-dose group and 46 years in the single-dose group, while the median body mass index was 23 kg/m² in both groups. The primary outcome of SSI leading to surgical removal of the implant within 6 months after surgery occurred in 30 patients (4.3 percent) overall. Meanwhile, 47 patients (7.0 percent) were readmitted for intravenous antibiotics because of SSI, and 190 women (27.7 percent) were given oral antibiotics because of clinically suspected SSI.

There was no significant between-group difference in the primary outcome of implant removal (odds ratio [OR], 1.26, 95 percent confidence interval [CI], 0.69–2.65; p=0.53) and the secondary outcomes of readmission for intravenous antibiotics (OR, 1.18, 95 percent CI, 0.65–2.15; p=0.58) and prescription of oral antibiotics (OR, 0.72, 95 percent CI, 0.51–1.02; p=0.07).

Furthermore, significantly more patients in the multiple-dose group than in the single-dose group developed adverse events associated with antibiotic treatment (16.4 percent vs 10.7 percent; OR, 1.64, 95 percent CI, 1.05–2.55; p=0.03).

The findings suggest that multiple-dose intravenous antibiotic prophylaxis is not recommended for the prevention of postoperative infection after implant-based breast reconstruction because of the associated higher rates of adverse events.