ENOVAT review questions routine surgical antibiotic prophylaxis

A new systematic review and meta-analysis underpinning the ENOVAT surgical antimicrobial prophylaxis guidelines found that, across companion animal surgeries, prophylactic antimicrobials had only a trivial to small clinical effect on reducing surgical site infections in dogs and cats. The review, published in the Journal of Small Animal Practice, included eight randomized controlled trials and seven observational studies, and grouped procedures into nine surgical categories spanning soft tissue and orthopedic surgery. That evidence now feeds directly into the ENOVAT 2025 guidelines, which issue 10 strong recommendations against surgical antimicrobial prophylaxis, three conditional recommendations against, and five conditional recommendations for its use. (pubmed.ncbi.nlm.nih.gov)

Why it matters: For veterinary professionals, the message is less about abandoning prophylaxis entirely and more about narrowing its use to cases where benefit is likely to outweigh harm. The guideline panel said strong recommendations against prophylaxis were often based on low- to very low-certainty evidence showing no meaningful benefit, weighed against well-established harms of unnecessary antimicrobial use. That aligns with existing antimicrobial stewardship guidance from AAHA/AAFP, which says prophylaxis is not usually needed for clean procedures and that postoperative antibiotics are rarely required, as well as Washington State University guidance stating antibiotics are not warranted for routine surgical procedures. (pubmed.ncbi.nlm.nih.gov)

What to watch: Watch for national and regional groups to adapt the ENOVAT evidence into local protocols, especially around peri-operative timing, postoperative use, and procedure-specific exceptions. (pubmed.ncbi.nlm.nih.gov)