European Network for Optimization of Veterinary Antimicrobial Therapy (ENOVAT) 2025 guidelines for surgical antimicrobial prophylaxis in dogs and cats

Surgical antimicrobial prophylaxis involves the administration of antimicrobials to reduce the risk of a surgical site infection and represents a significant proportion of all antimicrobial use in cats and dogs. This evidence-based, European Network for Optimization of Veterinary Antimicrobial Therapy guideline provides recommendations for both peri- and post-operative surgical antimicrobial prophylaxis for a wide range of soft tissue and orthopaedic procedures performed in dogs and cats. A multidisciplinary panel developed the recommendations while adhering to the Grading of Recommendations Assessment, Development and Evaluation framework. The opinions of veterinary practitioners were incorporated to ensure applicability. Ten strong recommendations against, three conditional recommendations against and five conditional recommendations for the use of surgical antimicrobial prophylaxis were drafted by the panel. Strong recommendations against surgical antimicrobial prophylaxis were often informed by low- to very low-certainty evidence that treatment has no beneficial effect. However, the anticipated harmful effects of antimicrobial use are well established and offer an important counterbalance to unsubstantiated use. Conditional recommendations were made when there was a probable balance of effects in one direction, although appreciable uncertainty was present. The European Network for Optimization of Veterinary Antimicrobial Therapy guidelines initiative encourages national or regional guideline makers to use the evidence presented in this document and the supporting systematic review to draft national or local guidance documents that support rational surgical antimicrobial prophylaxis.