Are antibiotics mandatory after surgery?

Question

I really don’t like taking antibiotics because they mess up my stomach so much and my doctor is putting me on a seven day course of antibiotic after my procedure in a week. Do I have to take them or is it OK not to take them

Justin Yovino, MD, FACS · Answer

Antibiotics are notoriously over prescribed especially for elective cosmetic surgery. If a patient refuses antibiotics for surgery, we still proceed. I’ve never had a problem with that approach

Semih Yildiz, MD, FEPOBRAS · Answer

Antibiotic protocols vary by surgeon, procedure, implant use, and individual risk factors. For a breast lift with implants, many surgeons are more cautious because an implant infection can be a serious complication. A seven-day oral course is not universal for every surgeon, but if your surgeon prescribed it for your operation, you should not simply skip it on your own.

The best step is to contact your surgeon before surgery and explain exactly what happens to your stomach with antibiotics. They may be able to choose a different antibiotic, adjust the timing with food if appropriate, recommend a probiotic or stomach-protection strategy, or decide whether a shorter course is reasonable for your case. If you develop severe diarrhea, rash, breathing difficulty, or signs of an allergic reaction, you should seek medical help promptly. The key is to make the plan with your surgical team rather than stopping it independently.

James M. Economides, MD, FACS · Answer

It’s understandable that you’re concerned about taking antibiotics, especially if they cause stomach issues for you. However, post-surgical antibiotics are often prescribed to prevent infection, which can be a serious complication after any procedure. Whether or not you must take them depends on your individual situation, but here are a few key considerations:

Purpose of Antibiotics: After surgery, the risk of infection is higher, especially when incisions are involved. Antibiotics are prescribed to lower that risk and help your body heal without complications. An untreated infection can lead to more serious issues and even affect the success of your surgery.

Alternative Options: Some people are more sensitive to certain types of antibiotics. If you’ve experienced significant stomach issues in the past, you might want to discuss this with your doctor. There could be alternative antibiotics that are gentler on your stomach or even non-oral options like topical or intravenous antibiotics, depending on your specific case.

Probiotics and Stomach Support: If you do need to take antibiotics, you might also want to consider using probiotics or eating probiotic-rich foods (like yogurt or kefir) to help balance your gut bacteria and minimize stomach upset. This can sometimes lessen the gastrointestinal side effects of antibiotics.

Skipping Antibiotics: Not taking the prescribed antibiotics increases the risk of infection, which can lead to serious complications. It's generally not recommended to skip them without discussing it with your surgeon. They can evaluate your risk for infection and determine if the antibiotics are essential for your particular procedure.

It’s really important to have an open conversation with your doctor about your concerns. They may be able to offer a solution that helps protect your stomach while also ensuring that you’re protected from infection.

Daniel Barrett, MD · Answer

Dear Eclectic223178,
every plastic surgeon has his own preoperative protocol which he recommends to his patients. Most surgeons try to reduce the antibiotics use. I would suggest you to discuss this with your plastic surgeon.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gerald Minniti, MD, FACS · Answer

You do not indicate what your surgery is, but if it is elective cosmetic surgery, data shows that only a single dose of intravenous antibiotics administered 30 minutes prior to incision is necessary, and that any post operative oral antibiotics DO NOT reduce your risk of infection. The only exception to this rule is breast implant surgery, where 24 hours of oral antibiotics after surgery can POSSIBLY reduce your risk of capsular contracture. 7 days of post operative antibiotics is completely unnecessary and potentially harmful to you and to society at large.

Connie Hiers, MD, FACS · Answer

If you are getting implants, you need antibiotics. Go ahead and start taking probiotics and stay on them for at least 3 months. Nipples are an open system and do contain bacteria. When placing implants, the nipples are disturbed, and bacteria are released into the blood. If the bacteria get around the implants you will either develop an infection or a capsule. Either of these may need additional surgery. Talk to your medical doctor for further advice.

Mats Hagstrom, MD (license on probation) · Answer

No one is going to tell you it’s OK to not follow your doctors recommendations or to not take medication’s. A doctor has prescribed for you.
Giving such a recommendation would be highly inappropriate.
I certainly wouldn’t want another doctor to tell my patients to do something different than my prescribed Postoperative instructions or management.
Each provider will have their own post operative protocol for the use of antibiotics.
Anytime we’re dealing with implants or insertion of a foreign body sterility and minimizing. The chance of infections is taken very seriously.
It takes very little bacteria to contaminate a breast implant and cause an infection.
If a patient develops an infection around an implant, the consequence is devastating.
When placing implants, I personally would insist inpatient taking antibiotics.
That said the only thing that has been proven to reduce postoperative infections is a single dose of antibiotics immediately before surgery.
The great majority of plastic surgeons use antibiotics after surgery and I would venture to guess that almost all plastic surgeons use them postoperatively when placing implants especially.
If you have concerns about the treatment plan and the correct person to bring this up with is your surgeon.
In the end, lots of patients don’t follow our recommendations and do whatever they want to.
Whether that is smart is a different conversation.
There’s a reason why your doctor wants you to take antibiotics.
As doctors, we know if there is a risk to the use of antibiotics including G.I. upset, developing diarrhea, vaginal yeast infections, creating antibiotic resistance and potentially much worse. 
Doctors rely on scientific validation and proof for what is used.
The scientific literature is not strong and supporting the use of postoperative antibiotics.
Doctors also need to rely on something called community standards, which is sort of following the herd or doing what everybody else does.
This means if a patient develops an infection and the surgeon did not prescribe antibiotics. A lawyer can easily win a lawsuit because all the other plastic surgeons in the community do prescribe antibiotics.
I don’t think this is why we prescribe antibiotics but following community standards is something doctors are aware of and are expected to follow to some degree.
The infection rate for breast augmentation is relatively low, but when infections happen, they are as I mentioned previously quite devastating.
Talk to your provider if you have questions or concerns.
It’s not wrong to have a follow up visit or a pre op appointment if your questions have not been addressed.
Good luck with your upcoming procedure.
Best,
Mats Hagstrom MD

Are antibiotics mandatory after surgery?

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