Laparoscopic cholecystectomy (LC) is one of the most commonly performed general surgical procedures and represents a major source of perioperative antimicrobial exposure. Although infectious complication rates are low, variability in antibiotic prescribing persists, particularly in elective low-risk cases. This narrative review synthesises contemporary evidence regarding perioperative antimicrobial prophylaxis in low and high-risk LC, with a focus on SSI outcomes, guideline recommendations and antimicrobial stewardship implications. A structured literature search of MEDLINE, Embase and the Cochrane Library was performed, including randomised controlled trials, observational studies, systematic reviews, meta-analyses and international guidelines published between 2010 and 2025. The evidence consistently demonstrates no clinically meaningful reduction in SSI rates with routine prophylactic antibiotics in low-risk elective LC. Despite this, antibiotic use remains widespread. In high-risk LC, particularly acute cholecystitis, baseline SSI risk is increased; however, current evidence does not reliably demonstrate benefit from broad-spectrum agents, extended prophylaxis or postoperative antibiotics. Several meta-analyses report no reduction in infectious complications and identify increased hospital length of stay associated with antibiotic use. International guidelines uniformly discourage prophylaxis in low-risk LC but vary in their recommendations for high-risk patients, reflecting ongoing uncertainty and limited high-quality data. From a stewardship perspective, LC represents a high-impact opportunity to reduce unnecessary antimicrobial exposure through risk stratification, standardised single-dose prophylaxis where indicated and avoidance of postoperative continuation in the absence of established infection. In conclusion, omission of prophylactic antibiotics in low-risk LC is strongly supported by current evidence. Antibiotic use in high-risk LC should be individualised and evidence-informed, with further high-quality trials required to define optimal practice.