Currently, there are no data to support the administration of postoperative antibiotic therapy, and it is not recom- mended because of the risk of drug adverse events, selection of drug-resistant organisms, and cost. Recommendations for Antimicrobial Prophylaxis at the Time of CIED Placement Class I 1. Prophylaxis with an antibiotic that has in vitro activity against staphylococci should be administered. If cefazolin is selected for use, then it should be administered intrave- nously within 1 hour before incision; if vancomycin is given, then it should be administered intravenously within 2 hours before incision. (Level of Evidence: A) Antibiotic Prophylaxis for Invasive Procedures Bacterial pathogens commonly gain entrance to the circulation, whether from routine daily activities such as toothbrushing or from invasive procedures.93 There is a general and longstanding focus on secondary antibiotic prophylaxis to prevent hematog- enous infections from invasive procedures in patients with a wide variety of medical devices and conditions. However, controversy surrounds this practice because there are few data to show efficacy, and the risk from prophylaxis likely outweighs any benefit. For example, there is concern about the develop- ment of antibiotic-resistant bacterial pathogens, the possibility of a fatal allergic reaction, and the costs associated with this practice, which include malpractice litigation and, additional medical and dental office visits. 