Single-dose versus multiple-dose antibiotic prophylaxis in elective laparoscopic cholecystectomy

Abstract

The benefit of continuing prophylactic antibiotics beyond the perioperative period in elective laparoscopic cholecystectomy remains uncertain. Prolonged antibiotic exposure may increase healthcare costs, adverse drug events, and antimicrobial resistance without providing additional clinical benefit. This systematic review was conducted between May and July 2026 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Adults aged 18 years or older undergoing elective laparoscopic cholecystectomy were eligible. Studies directly comparing single-dose perioperative antibiotic prophylaxis with multiple-dose or prolonged prophylaxis were included. The primary outcome was postoperative surgical-site infection or a clinically equivalent infectious complication. Randomized studies were assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, while non-randomized studies were assessed using ROBINS-I. A narrative synthesis was performed because of clinical and methodological heterogeneity. Eighteen eligible studies involving 3,448 participants were included. Of these, 1,723 participants received single-dose prophylaxis and 1,725 received multiple-dose or prolonged prophylaxis. Most studies reported no statistically significant difference in postoperative infectious outcomes between the two strategies. Haider et al. reported significantly fewer postoperative infections in the single-dose group, whereas the remaining evidence generally showed comparable outcomes. Secondary outcomes, including hospital length of stay and healthcare resource utilization, were inconsistently reported. In adults undergoing uncomplicated elective laparoscopic cholecystectomy, single-dose perioperative antibiotic prophylaxis appears to provide postoperative infectious outcomes comparable to multiple-dose or prolonged regimens. The available evidence does not demonstrate a consistent clinical benefit from extending prophylaxis beyond the perioperative period. These findings should be interpreted in light of the methodological heterogeneity, limitations in study quality, and inconsistent outcome reporting across the included studies.