For a simple uncomplicated lipoma excision, how many antibiotic doses are required?

Antibiotic Prophylaxis for Lipoma Excision

For a simple uncomplicated lipoma excision, no antibiotic prophylaxis is required—lipoma excision is classified as clean surgery (Altemeier Class 1) and does not routinely warrant any antibiotic doses. 1

When Antibiotics Are NOT Indicated

• Simple lipoma excision does not require antibiotic prophylaxis because it is clean surgery without evidence supporting antimicrobial coverage 1
• The National Institute for Health and Care Excellence (NICE) explicitly classifies lipoma excision as clean surgery that does not routinely require prophylaxis unless specific high-risk factors are present 1
• In a day surgery audit of 44 lipoma excisions, only one patient (2.27%) developed a deep incisional infection despite all patients receiving prophylaxis, suggesting the baseline infection risk is extremely low 2

High-Risk Scenarios Requiring Single-Dose Prophylaxis

If patient-specific risk factors are present, administer ONE single preoperative dose only—never extend antibiotics postoperatively. 3, 1

High-risk factors include:

• Known MRSA colonization 1
• Hospitalization within the past 3 months in high-risk units 1
• Recent antibiotic exposure (within 3 months) 1
• Immunosuppression 1
• Diabetes mellitus 1
• Hemodialysis 1

Single-Dose Prophylaxis Regimen (If Indicated)

Standard regimen:

• Cefazolin 2g IV administered 30-60 minutes before surgical incision 1
• For patients weighing ≥120 kg: Cefazolin 4g IV 1
• Re-dose cefazolin 1g IV only if procedure exceeds 4 hours or blood loss exceeds 1.5 liters 1

Beta-lactam allergy alternatives:

• Clindamycin 900 mg IV slow PLUS gentamicin 5 mg/kg/day as a single dose 1
• OR Vancomycin 30 mg/kg IV (infused over 120 minutes minimum) for penicillin allergy or known MRSA colonization 1

MRSA colonization (dual coverage):

• Vancomycin 30 mg/kg IV PLUS cefazolin 2g IV for patients with documented MRSA colonization 1

Critical Timing: No Postoperative Antibiotics

There is no evidence that extending antibiotics beyond 24 hours reduces infection rates—all antibiotic prophylaxis must be discontinued within 24 hours after surgery. 3, 4, 1

• The World Health Organization, CDC, and multiple international guidelines explicitly state that postoperative antibiotic prophylaxis is not supported by evidence 3, 4
• A single preoperative dose is adequate for the majority of procedures 3
• Extending antibiotics beyond 24 hours increases antimicrobial resistance, Clostridium difficile infection, hypersensitivity reactions, and renal failure without reducing SSI rates 4

Common Clinical Pitfall

The presence of surgical drains does NOT justify extending antibiotic prophylaxis beyond 24 hours. 4

• Proper drain management (placing drains through subcutaneous tunnels and removing them when output is <30 ml/day or by 7-14 days maximum) is more important than antibiotic coverage 4
• The American Society of Health-System Pharmacists advises against routine postoperative antibiotics, as this practice is not evidence-based and contributes to resistance 1

Target Bacteria (If Prophylaxis Used)

• Primary target: Methicillin-susceptible Staphylococcus aureus and skin flora 1
• Cefazolin provides appropriate coverage for Gram-positive skin commensals most likely to contaminate the surgical site 3