Antibiotic prophylaxis in elective laparoscopic cholecystectomy: a narrative review of efficacy, safety, and antimicrobial stewardship.

Elective laparoscopic cholecystectomy (LC) is associated with a low but measurable risk of surgical-site infection (SSI), with rates of 1-3% when antibiotics are withheld. This review evaluates randomized controlled trials, cohort studies, and meta-analyses published through June 2024 to assess the benefits and risks of perioperative antibiotic prophylaxis in low-risk patients. Evidence indicates that single- or multiple-dose regimens, most commonly cefazolin, reduce superficial SSI by 33-39% (relative risk 0.61-0.67; P < 0.01), equating to absolute risk reductions of 1.5-2.0% and numbers needed to treat between 30 and 50. There is no clear effect on deep or organ-space infections, which remain exceedingly rare. Antibiotic use carries potential harms, including Clostridioides difficile infection, allergic reactions, and the promotion of antimicrobial resistance. Current guidelines from leading surgical and infectious-disease societies recommend against routine prophylaxis in healthy individuals undergoing elective procedures to support antimicrobial stewardship. While selective prophylaxis may be warranted for patients with identifiable risk factors such as intraoperative bile spillage or significant comorbidities, routine administration in otherwise low-risk elective LC is not justified by the balance of evidence.