Comparative Effectiveness of Single-Dose vs. Multi-Dose Prophylactic Antibiotics in Reducing Post-Surgical Infections: A Systematic Review and Meta-Analysis.

BACKGROUND

Surgical site infections (SSIs) are among the most frequent and costly postoperative complications, contributing to increased morbidity, extended hospitalization, and healthcare burden. Although guidelines support single-dose antibiotic prophylaxis for most surgeries, multi-dose regimens remain widely used in clinical practice, especially in high-risk procedures. This review aimed to compare the effectiveness of single-dose versus multiple-dose prophylactic antibiotic regimens in preventing postoperative infections.

METHODS

A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. Databases including PubMed, Scopus, CENTRAL, Web of Science, and ScienceDirect were searched up to February 2025. Studies involving human participants undergoing surgery, comparing single- and multiple-dose antibiotic prophylaxis with infection-related outcomes, were included. Risk of bias was assessed using the Cochrane RoB 2.0 and MINORS tools. Meta-analyses were performed using random-effects models.

RESULTS

Forty-seven studies encompassing various surgical disciplines and patient populations were included. No statistically significant difference in SSI rates was observed between single- and multiple-dose groups (OR: 1.10 [95% CI: 0.87-1.39], p = 0.43). Similarly, no differences were detected for other postoperative infections, mortality, or readmissions. Heterogeneity was moderate to high across analyses. Most studies reported comparable infection outcomes despite differences in antibiotic type, follow-up duration, and surgical setting.

CONCLUSION

Single-dose antibiotic prophylaxis is as effective as multiple-dose regimens in reducing postoperative infections in most surgical contexts. These findings support current recommendations favoring single-dose administration and reinforce antimicrobial stewardship efforts. Extended prophylaxis should be reserved for selected high-risk cases rather than routine use.