Antibiotic Prophylaxis for Subdermal Implant Removal
Antibiotic prophylaxis is not recommended for routine subdermal implant removal in the outpatient setting. 1
Rationale for No Prophylaxis
Clean minor procedures do not require prophylaxis. Subdermal implant removal is a clean, minor surgical procedure that does not involve implantation of foreign material or high infection risk, and therefore does not meet criteria for antibiotic prophylaxis 1
WHO and CDC guidelines specify prophylaxis only for procedures with high SSI rates or when foreign materials are implanted. Since implant removal involves extracting rather than placing foreign material, prophylaxis is not indicated 1
Postoperative antibiotics are explicitly not recommended. Even for procedures where preoperative prophylaxis is given, antibiotics should not be continued after surgery, as there is no evidence supporting this practice 1
When Prophylaxis Would Be Indicated
If prophylaxis were needed (which it is not for routine removal), the following would apply:
Single preoperative dose only. A single dose of cefazolin 2g IV administered 30-60 minutes before incision would be the standard approach for clean procedures involving foreign materials 2
Alternative for penicillin allergy. Clindamycin 900mg IV slow infusion would be the preferred alternative for patients with beta-lactam allergy 2, 3
Critical Pitfalls to Avoid
Do not prescribe prophylactic antibiotics for routine subdermal implant removal. This increases antibiotic resistance without reducing infection rates and exposes patients to unnecessary adverse events 1, 4
Do not confuse implant removal with implant placement. The evidence supporting prophylaxis for dental implants, breast implants, and other prosthetic device placement does not apply to device removal 5, 6, 7
Recognize that adverse events from antibiotics are common. Multiple-dose regimens cause adverse events in 16.4% of patients compared to 10.7% with single-dose, and both are unnecessary for implant removal 4
Infection Prevention Without Antibiotics
Strict aseptic technique is sufficient. Meticulous hand hygiene, proper skin preparation, and sterile technique are the appropriate infection prevention measures for this procedure 1
Reserve antibiotics for actual infections. If signs of infection develop (pain, swelling, redness, heat, fever), then therapeutic antibiotics—not prophylaxis—would be indicated 1