Antibiotic use in emergency general surgery: What you need to know

ABSTRACT: Antimicrobials are among the classes of pharmaceuticals most used by acute care surgeons, with many emergency general surgery conditions either related to infections or at high risk of infectious complications. As such, knowledge of proper use of antimicrobial agents, especially in this era of increasing antimicrobial resistance, is imperative for optimal outcomes. This review focuses on the advanced infectious diseases and antimicrobial utilization knowledge required to treat complicated and critically ill surgical patients. Overall concepts pertaining to antibiotics are discussed, followed by a more in-depth discussion of conditions common in emergency general surgery. Key themes include the importance of source control and accurate culture data, the frequent need for broad-spectrum, empiric antimicrobial therapy, subsequent careful de-escalation of antibiotics, and minimizing treatment duration. (J Trauma Acute Care Surg. 2026;101: 13-27. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.).