Is empiric prescribing of antibiotics as prophylaxis the biggest cause of AMR? Antimicrobial resistance (AMR) has become one of the defining healthcare threats of the twenty-first century. While public discussion often focuses on inappropriate antibiotic treatment of infections, a substantial and underappreciated contributor to AMR is the routine use of prophylactic antibiotics, particularly in elective surgical care. Antibiotic prophylaxis has transformed modern medicine by making complex surgery safer and by reducing surgical site infections (SSIs). However, the widespread and often excessive use of prophylactic antibiotics has also created powerful evolutionary pressure favouring resistant organisms. The paradox is striking. The same drugs that enabled modern surgical care are now threatening its long-term sustainability. We have arrived at the stage where cures have become foes. Healthcare systems increasingly face a difficult balance between preventing immediate postoperative infections and preventing long-term antimicrobial resistance. The costs associated with AMR are no longer theoretical. Hospitals are experiencing longer admissions, increased ICU occupancy, more expensive therapies, greater readmission rates, and rising mortality associated with resistant infections. Insurers and public payers are …