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Comment & Response
August 7, 2019

Preoperative Topical Decolonization—An Additional Strategy to Reduce Oral Antibiotic Prophylaxis for Mohs Infections?

Author Affiliations
  • 1Oxford Dermatology, Perth, Australia
JAMA Dermatol. 2019;155(9):1089. doi:10.1001/jamadermatol.2019.2139

To the Editor The article by Barbieri et al1 draws attention to the 40% increase over a 10-year period in the prescription of oral antibiotics following Mohs surgery. They note that a uniform approach to prescribing may reduce this by as much as 50%. The article highlights that the median prescription length was 7 days and that a reduction of this would be facilitated by the adoption of a single-dose oral antibiotic schedule following the 2008 Journal of the American Academy of Dermatology advisory statement on antibiotic prophylaxis.2 The statement proposes anatomical locations and repairs that may carry an enhanced risk of infection. The authors of the statement write that “the data underlying these [risk] factors are suboptimal.” Statistically, the statement, which uses non-Mohs surgery data, appears strongest for assigning risk to lower limb location and graft or flap repairs. Furthermore, the developing literature has failed to note a statistically significant reduction in Mohs infection after oral antibiotic prophylaxis.3

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