Alternatives to quinolone antibiotic for post facelift prophylaxis?

Question

My surgeon is recommending a short course of Levofloxacin post facelift surgery. I prefer not to take quinolone antibiotics due to the risk for severe side effects. To those surgeons who use post surgical prophylaxis, what antibiotic do you routinely prescribe?

Joon Y. Choi, MD · Answer

Hi. The choice and duration of post facelift antibiotic therapy varies among surgeons. I personally use preoperative IV Ancef followed by a week of Keflex (oral form of the same antibiotics, broad spectrum). Some surgeons may not use any postoperative antibiotics at all since infection risks after facelift are quite low. I recommend asking for a different type of antibiotics or none if quinolone sounds like a risky proposition to you. There are so many kinds of antibiotics available.

Stephen Prendiville, MD · Answer

Truthfully, antibiotics in the perioperative period are what we describe as a "belt and suspender" approach, in that you truly don't "need" them.  Wound infections with facelift are statistically rare, but they can happen.  Things that aren't antibiotic related that I recommend 1) Follow wound care instructions, 2) Keep your fingers, which have lots of bacteria, off the wounds, 3) Stay away from nursing homes and hospitals, which have higher rates of antibiotic resistant bacteria in a community setting, 4) Use a clean water source for bathing, not well water, 5) Rinse with Chlorhexidene the night before and morning of surgery. Wound infections (rare) can happen even if you are on antibiotics, so it's best to follow the guidelines above.

Jeffrey M. Darrow, MD · Answer

As long as you’re not allergic to any antibiotics, and you don’t have a history of harboring any difficult to treat bacteria, such as methicillin resistant staph aureus, most facelift surgeries are easily covered with a first generation cephalosporin. Usually it’s given intravenously at the start of anesthesia  and then perhaps one or two doses afterwards.  Infections are relatively rare after facelift. Discuss this in detail with your plastic surgeon. Best wishes.

Jacob Tower, MD · Answer

Hello, hope you are well. Antibiotics are not necessarily needed postop for facelift surgery, but if prophylaxis is going to be given a cephalosporin is typically prescribed. 
Best,Dr. Tower

Ronald J. Edelson, MD · Answer

It is only necessary to give one dose of antibiotics during surgery. This has been shown over and over again for years. Postoperative antibiotics are not necessary. However there are plenty of options for post op antibiotics as well. I would use Keflex

William Portuese, MD · Answer

In our practice, there's no reason to do post facelift prophylaxis, since we give antibiotics during the procedure itself. It's very rare to have an infection after a facelift procedure list or some underlying immune issue or you're a smoker

Mark Eberbach, MD · Answer

There really is no need for any postoperative prophylactic antibiotics in any plastic surgery procedure that is clean and does not involve implants.

Mats Hagstrom, MD (license on probation) · Answer

There is a good science that is single dolls of intervenous. Antibiotics at the beginning of surgery decreases postoperative infections. There’s less signs supporting the use of antibiotics after surgery.
I think most surgeons use first generation cephalosporin’s, such as Ancef or Keflex. 
With the increased incidence of resistant bacteria, some providers have started using different anabiotic’s.
Talk to your provider about your concerns to see if they are amenable to using a different anabiotic if you’ve had bad experiences with what they recommend.
The standard of care in the plastic surgery community it’s not always supported by good science.
Best,
Mats Hagstrom, MD

Alternatives to quinolone antibiotic for post facelift prophylaxis?

Answers (8)

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