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Background  First‐generation cephalosporins (such as cefazolin) are recommended as antibiotic prophylaxis in groin hernia repair, but other broad‐spectrum antibiotics have also been prescribed in clinical practice. This was a systematic review and network meta‐analysis to compare the efficacy of different antibiotic classes for prevention of surgical‐site infection ( SSI ) after hernia repair.    Methods   RCTs  were identified that compared efficacy of antibiotic prophylaxis on  SSI  after inguinal or femoral hernia repair from  PubMed  and Scopus databases up to March 2016. Data were extracted independently by two reviewers. Network meta‐analysis was applied to assess treatment efficacy. The probability of being the best antibiotic prophylaxis was estimated using surface under the cumulative ranking curve ( SUCRA ) analysis.    Results  Fifteen  RCTs  (5159 patients) met the inclusion criteria. Interventions were first‐generation (7  RCTs , 1237 patients) and second‐generation (2  RCTs , 532) cephalosporins, β‐lactam/β‐lactamase inhibitors (6  RCTs , 619) and fluoroquinolones (2  RCTs , 581), with placebo as the most common comparator (14  RCTs , 2190). A network meta‐analysis showed that β‐lactam/β‐lactamase inhibitors and first‐generation cephalosporins were significantly superior to placebo, with a pooled risk ratio of 0·44 (95 per cent c.i. 0·25 to 0·75) and 0·62 (0·42 to 0·92) respectively. However, none of the antibiotic classes was significantly different from the others.  SUCRA  results indicated that β‐lactam/β‐lactamase inhibitors and first‐generation cephalosporins were ranked first and second respectively for best prophylaxis.    Conclusion  β‐Lactam/β‐lactamase inhibitors followed by first‐generation cephalosporins ranked as the most effective  SSI  prophylaxis for adult patients undergoing groin hernia repair.

Network meta‐analysis of antibiotic prophylaxis for prevention of surgical‐site infection after groin hernia surgery