When should prophylactic antibiotics be administered relative to incision time, and why?

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Prophylactic antibiotics work best when tissue levels are already high at the moment the incision is made, so bacteria that enter the wound encounter the drug immediately and infection is less likely to start. That’s why they should be given within about an hour before incision for most antibiotics, ensuring peak tissue concentrations during the procedure. Some agents, like vancomycin or certain fluoroquinolones, take longer to infuse, so they should be started earlier and finished by incision time, typically within 120 minutes before incision. If the operation is prolonged or there’s significant blood loss, intraoperative redosing helps maintain protective levels. Administering antibiotics after incision or postoperatively, or only when fever arises, doesn’t provide the necessary protective tissue levels during the procedure.