Administration of peri-operative antibiotics within 60 minutes after the start of surgery, and particularly after skin incision, appears to ensure adequate drug concentration in the serum and tissues at the site of surgery so as to reduce the risk of postoperative infection. The antibiotic of choice in peri-operative prophylaxis should be active against the most common pathogens present at the surgical site and should be administered at an appropriate dosage, for the shortest possible time suitable to achieve effective serum and tissue concentrations and minimize adverse effects. Generally, a single dose of antibiotic prior to the procedure is sufficient; however, additional intraoperative administration may be necessary if the duration of the procedure exceeds the two half-lives of the antimicrobial agent used or if excessive blood loss occurs during the procedure. Prolonged administration of peri-operative prophylaxis should be reserved for selected cases (e.g., presence of catheters/drainage, underlying infections) as it may result in selection of antibiotic- resistant bacterial strains, the emergence of nosocomial infections, and the occurrence of Clostridium difficile colitis.

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