The aim of this study was to evaluate adherence to current local antimicrobial prophylaxis guidelines for children requiring different surgical procedures. One hundred and fifty consecutive surgical procedures on children were included in this retrospective study of adherence. The indication, choice of antibiotic, timing, dose, duration and dosing interval were evaluated and found to be concordant with present local guidelines in 97.3%, 83.3%, 66%, 92%, 40.7% and 94.1% of cases, respectively. Adherence to all parameters was achieved in only 25.3% of cases. Although the overall adherence to antibiotic prophylaxis guidelines was relatively low, the majority of children (84.6%) received an appropriate antibiotic (90.6%) at the appropriate dose (92%) and at appropriate intervals (94.1%). The most discordant duration of prophylaxis was due to controversies in urological prophylaxis guidelines.