Antimicrobial resistance is no longer a problem confined to infectious disease wards. It is increasingly becoming part of everyday surgical practice. Clear evidence of this shift is provided by an international report published in December 2025 in the prestigious journal Antibiotics, focusing on strategies to prevent infections after cataract surgery across different European countries.
The authors—an international team of ophthalmologists and microbiologists from ten countries—analyzed national approaches to postoperative prophylaxis and concluded that excessive use of antibiotics does not improve patient safety and, in the long term, may actually reduce it.
An End to “Just-in-Case” Antibiotics
One of the key conclusions of the publication is that in most of the countries analyzed, routine preoperative antibiotic use before cataract surgery has been completely abandoned. Cataract surgery is now recommended primarily in patients without active infectious diseases of the ocular surface.
Instead, emphasis is placed on: effective antisepsis of the surgical field, a single intraoperative dose of antibiotic, short, precisely defined postoperative therapy.
As the authors stress, long-term antibiotic regimens that are gradually tapered lack solid scientific justification and promote the selection of antibiotic-resistant bacterial strains.
Clear Points of Consensus
Despite differences between countries, the publication identifies several common elements of current best practice: widespread use of povidone-iodine as the primary antiseptic agent, single-dose intracameral administration of cefuroxime during surgery, short-term—most often seven-day—postoperative use of topical antibiotics, mainly from the fluoroquinolone group.
The authors emphasize that levofloxacin remains one of the most effective antibiotics in ophthalmology, but its continued effectiveness depends on rational and responsible use.
The Polish Contribution and the Lublin Experience
The lead author of the report is Professor Mario Damiano Toro from Italy, who for several years collaborated and trained at the University Clinic of General Ophthalmology in Lublin, headed by Professor Robert Rejdak. The experience gained in Poland—including the model of short, intensive postoperative therapy—became an important reference point for the international team of authors.
The publication was developed through collaboration among experts from ten European countries and reflects a clear shift in thinking about postoperative prophylaxis: fewer antibiotics, used in a precise, short-term, and evidence-based manner. Among the authors representing Poland are Professor Robert Rejdak and Professor Izabela Korona-Głowniak.
The report highlights the role of clinical environments that had already implemented antibiotic-sparing strategies based on evidence-based medicine and long-term clinical observations.
Responsibility Instead of Routine
The authors of the Antibiotics report do not call for abandoning antibiotics altogether, but rather for moving away from routine, habitual prescribing. In an era of rapidly increasing antimicrobial resistance, the key priorities are: shortening the duration of therapy, precise selection of medications, individualized treatment strategies, protection of effective antibiotics from overuse.
As the example of ophthalmology demonstrates, modern surgery can be both safe for patients and responsible from a public health perspective. (JC)
