Surgical antibiotic prophylaxis in clean elective upper limb soft-tissue surgery in a resource-limited setting: a randomized, double-blind, placebo-controlled trial.

Routine surgical antibiotic prophylaxis (SAP) is frequently used to prevent surgical site infections, although its benefit in clean elective upper limb soft-tissue surgery remains questionable due to the low baseline risk of infection. This issue is particularly relevant in resource-limited settings, where concerns about infection and limited locally generated evidence often sustain routine antibiotic use. This study evaluated whether SAP provides clinical benefit in this context using a randomized, double-blind, placebo-controlled design. A total of 110 adult patients undergoing clean outpatient upper limb surgery were allocated to receive either a single preoperative dose of antibiotics or placebo. Surgical site infection rates were low and equivalent in both groups (1.8%), with no meaningful differences in postoperative wound complications. These findings suggest that routine SAP does not improve outcomes in this setting and support more judicious, evidence-based antibiotic use in low-risk surgical procedures, even in environments where perceived infection risk remains a concern.Trial registration: ClinicalTrials.gov NCT05990842.