Delabeling penicillin allergies in plastic and reconstructive surgery: Cefazolin as the cornerstone for antibiotic prophylaxis

Cefazolin is frequently used as surgical prophylaxis due to its efficacy in preventing surgical site infections (SSIs). However, in patients with reported history of allergy to penicillin, there is a disproportionate use of alternative antibiotic options for prophylaxis. This practice is associated with increased rates of surgical site infection, secondary infections, longer hospital stays, and higher healthcare costs. The use of these alternative options is based on several misconceptions on antibiotic safety; penicillin allergies are frequently over-recorded in the medical record, with <10% of reported patients being truly allergic to penicillin. Even in the case of true allergy, the risk of reactivity to cefazolin is extremely low due to its unique structure, as compared to penicillin/penicillin-like β-lactams. Improved patient outcomes may be achieved through increased clinician education on the safety of cefazolin for surgical prophylaxis, as well as thorough understanding of the rare cases where its use is truly contraindicated. Similarly, there are currently limited guidelines on the selection of prophylactic agents in the field of plastic surgery. Given the clinical evidence, cefazolin should be considered first in plastic surgery cases where antibiotic prophylaxis is indicated.