Antibiotic Prophylaxis in High‐Risk Head and Neck Surgery: One‐Day vs. Five‐Day Therapy

Abstract

Patients who undergo major contaminated surgery of the head and neck benefit from perioperative antibiotic prophylaxis. This study was developed to determine if 5 days of antibiotic administration would be more effective than 1 day. A multi-institutional prospective randomized double-blind study was designed. Patients who were identified as requiring pedicled flap reconstruction were potential candidates for the study. Later, patients were randomly assigned to receive cefoperazone sodium for either 24 hours or 120 hours. In each case, the drug was administered intravenously, beginning 1 to 2 hours preoperatively and continued for the prescribed period. One hundred nine patients were evaluable. Fifty-three patients were assigned to 1 day of perioperative prophylaxis. Wound infection developed in ten patients (18.9%). Fifty-six patients were assigned to 5 days of perioperative antibiotic prophylaxis. Wound infection developed in 14 (25%) of these patients (P greater than .05). These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours postoperatively can be achieved in patients who undergo myocutaneous flap reconstruction.

Prognostic significance of wound infections following major head and neck cancer surgery: an open non-comparative prospective study

“…The management and prevention of WI are real issues in perioperative care in head and neck cancer surgery. Because WI have been found to occur in up to 15% of patients despite antibiotic prophylaxis in all recent prospective studies [1,2,4,5,6,8,9,10,11,12,17,18,19,22,23,25,27,28,31,33,34], we must consider that major head and neck cancer surgery with opening of the upper aerodigestive tract is contaminated or dirty surgery [7]. Postoperative WI tend to be polymicrobial with mixed aerobic and anaerobic flora [3,9,13].…”

“…Comparative studies in head and neck cancer surgery have clearly shown the efficacy of antibiotic prophylaxis [2,8,9,31]. Different clinical controlled trials have shown that shortterm antibiotic prophylaxis (24 or 48 h) is as efficient as long-term antibiotic prophylaxis [11,17,18,25,28]. Short antibiotic prophylaxis reduces the risk of drug side effects and the risk of colonization and superinfection due to resistant pathogens.…”

“…Many studies have shown that the postoperative hospital stay is dramatically increased [18,23,30,34]. Alterations in quality of life and poor cosmetic results are evident, but no study has been carried out to analyse specifically these subjective parameters.…”

Antibiotic Use after Free Tissue Reconstruction of Head and Neck Defects: Short Course vs. Long Course

“…These data suggest that: (1) Antibiotic prophylaxis reduced infection rates [12][13][14]; (2) beta-lactam antibiotics are appropriate first-line agents, with clindamycin reserved for patients with beta-lactam allergies [12][13][14][15][16][17][18][19]; and (3) prolonged courses of antibiotics do not generally result in greater reduction of infection rates. [5,[20][21][22]. However, all these studies either excluded patients receiving free flaps or had only a small number of patients having free flaps.…”

Prevention and treatment of postsurgical head and neck infections

“…Several randomized, controlled, double-blinded studies comparing various lengths of antibiotic prophylaxis have failed to show a decrease in the incidence of postoperative wound infection by prolonging the length of prophylaxis [18][19][20]. This indicates that wound infections that occur despite antibiotic prophylaxis are not caused by an inadequacy or failure of prophylaxis, but by some other cause or causes.…”