I entirely agree with the recommendations made by Fayers et al. [1] to reduce antibiotic prescribing for chalazia and eyelid surgery but wonder whether the general title of the paper should have covered numerous other situations such as prophylaxis in viral conjunctivitis and corneal abrasion. One of the most common doubtful uses however is following cataract surgery. NICE guidance [2] comments that postoperative topical antibiotic prescribing is “part of standard practice” without advising it and recommending further research. Overall, 97% of ASCRS members use them [3], and the version of Medisoft EPR used at my institution produces a prescription for a 2 week ‘course’ of antibiotics without prompting the surgeon to confirm the default position.

According to The Scottish Intercollegiate Guidelines Network [4] which covers ophthalmic as well as other disciplines of surgery, appropriate surgical prophylaxis is usually defined as a single peroperative dose though this can be extended to a maximum of 24 h for orthopaedic implants. Prolonged courses are thought to be unhelpful or deleterious though evidence for this in cataract surgery is lacking. Herrinton et al. [5] found that addition of postoperative topical antibiotics to an intracameral application increased the incidence of endophthalmitis (odds ratio of 1.6) though they commented on a possible lack of significance with only 11,000 patients in the intracameral only group.

The NICE request for further research is well made but surgeons can be reassured that endophthalmitis will not become much more common if they discontinue this probably inappropriate antibiotic prescribing as I did 15 years ago. Doing so could clarify this topic through our national dataset.