Despite sufficient evidence of effectiveness, adherence to SAP guidelines is often suboptimal.2 In a previous study, the antibiotic dose was administered to 55.7% of patients within 1 hour before skin incision and antibiotics discontinued within 24 hours after surgery end time for only 40.7% of the patients.2 In Korea, only 15 (0.8%) of 1,895 patients who underwent a major surgical procedure received antibiotic prophylaxis in accordance with published guidelines in 2004.1 SAP quality, especially the timing of administration of the first dose, was significantly improved after the national hospital evaluation program (NHEP) for SAP of major surgery was started in 2007.1 Although the duration of SAP significantly decreased overall, antibiotics were discontinued within 24 hours after the end of surgery for only 12 (0.6%) among 1,949 surgical patients.1 Surgery under local anesthesia is currently not the subject of NHEP evaluation in Korea.

In this issue of the journal, Cha et al.4 compared the incidence of SSI in patients who received single-dose intravenous antibiotics only 1 hour before skin incision and those who received postoperative oral antibiotics only for 2–3 days in clean surgery under local anesthesia. They found that there was no difference in the incidence of SSI between the two groups. These results encourage and can be an important basis for surgeons to follow the SAP guidelines. They also demonstrated a low level of compliance to SAP guideline at the department of plastic surgery in 41 training hospitals in Korea. According to the telephone survey results, preoperative antibiotics were administered in 26.8% only and postoperative antibiotics were routinely prescribed at the time of discharge with a mean duration of 3.9 days.

Low compliance with the SAP guidelines may be due to a lack of knowledge of the guidelines, disagreements with the recommendations and a misconception that extending SAP duration could reduce the risk of SSI.5 Adequate antibiotic timing is critical to the effectiveness of prophylaxis, and prolonged antibiotic administration can be harmful to patients by promoting antibiotic-resistant bacteria and increasing the incidence of antibiotic-associated complications. Antibiotic resistance is a global public health threat that has as one of the main causes the massive overuse of antibiotics. In Europe, the prevalence of hospital antibiotic use is 35% and over 10% of these prescriptions are destined for SAP.5 Therefore, improving adherence to SAP guideline and appropriate use of SAP is an important element in the prevention of SSI and control of microbial resistance by preventing the selective pressure exerted by antibiotic use.