Antimicrobial Prophylaxis in Head and Neck Surgery

Panosetti, E.; Lehmann, Willy; Smolik, J. C.

doi:10.1159/000275928

Cited by 9 publications

(3 citation statements)

References 10 publications

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“…For unclear reasons, in a small RCT (n = 60), 48 hours of cefotaxime was superior to ceftriaxone despite both being third-generation cephalosporins (infection rates: 0% vs 3.3%, respectively, P < .05). 158 While a meta-analysis from 1991 has suggested that a 1-day course of clindamycin may be superior to other antibiotics, more recent trials regarding the effectiveness of clindamycin have had contradictory results. 151 Intraoperative use of low-dose cefazolin (500 mg) (but not higher doses) appears to increase infection rates relative to clindamycin-gentamicin.…”

Section: Discussionmentioning

confidence: 99%

Evidence‐Based Use of Perioperative Antibiotics in Otolaryngology

Patel

Jayawardena

Walden

et al. 2018

Otolaryngol.--head neck surg.

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Objective To identify and clarify current evidence supporting and disputing the effectiveness of perioperative antibiotic use for common otolaryngology procedures. Data Sources PubMed, Embase (OVID), and CINAHL (EBSCO). Review Methods English-language, original research (systematic reviews/meta-analyses, randomized control trials, prospective or retrospective cohort studies, case-control studies, or case series) studies that evaluated the role of perioperative antibiotic use in common otolaryngology surgeries were systematically extracted using standardized search criteria by 2 investigators independently. Conclusions Current evidence does not support routine antibiotic prophylaxis for tonsillectomy, simple septorhinoplasty, endoscopic sinus surgery, clean otologic surgery (tympanostomy with tube placement, tympanoplasty, stapedectomy, and mastoidectomy), and clean head and neck surgeries (eg, thyroidectomy, parathyroidectomy, salivary gland excisions). Antibiotic prophylaxis is recommended for complex septorhinoplasty, skull base surgery (anterior and lateral), clean-contaminated otologic surgery (cholesteatoma, purulent otorrhea), and clean-contaminated head and neck surgery (violation of aerodigestive tract, free flaps). In these cases, antibiotic use for 24 to 48 hours postoperatively has shown equal benefit to longer duration of prophylaxis. Despite lack of high-quality evidence, the US Food and Drug Administration suggests antibiotic prophylaxis for cochlear implantation due to the devastating consequence of infection. Data are inconclusive regarding postoperative prophylaxis for nasal packing/splints after sinonasal surgery. Implications for Practice Evidence does not support the use of perioperative antibiotics for most otolaryngologic procedures. Antibiotic overuse and variability among providers may be due to lack of formal practice guidelines. This review can help otolaryngologists understand current evidence so they can make informed decisions about perioperative antibiotic usage.

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Section: Discussionmentioning

confidence: 99%

Evidence‐Based Use of Perioperative Antibiotics in Otolaryngology

Patel

Jayawardena

Walden

et al. 2018

Otolaryngol.--head neck surg.

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“…What seems to be established is that antibiotic prophylaxis should be implemented with drugs or associations that are active on Gram-positive and Gram-negative bacteria and have good coverage against anaerobes. Clindamycin alone or in combination with other compounds active on both Gram-positive and Gram-negative bacteria [83][84][85], cefazolin alone or with metronidazole [86][87][88], other cephalosporins [89][90][91] and the combinations of amoxicillin/clavulanic acid [92,93] and ampicillin/sulbactam [94][95][96] are the most widely tested forms of antibiotic prophylaxis with no clear superiority. With regard to the duration of administration, it is not possible to draw definitive conclusions about the efficacy of a single dose of antibiotics before the start of surgery because studies in this regard are too limited.…”

Section: Scenario #8 Head and Neck Clean-contaminated Interventionsmentioning

confidence: 99%

Antimicrobial Prophylaxis in Neonates and Children Undergoing Dental, Maxillo-Facial or Ear-Nose-Throat (ENT) Surgery: A RAND/UCLA Appropriateness Method Consensus Study

et al. 2022

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Surgical site infections (SSIs) represent a potential complication in surgical procedures, mainly because clean/contaminated surgery involves organs that are normally colonized by bacteria. Dental, maxillo-facial and ear-nose-throat (ENT) surgeries are among those that carry a risk of SSIs because the mouth and the first respiratory tracts are normally colonized by a bacterial flora. The aim of this consensus document was to provide clinicians with recommendations on surgical antimicrobial prophylaxis in neonates (<28 days of chronological age) and pediatric patients (within the age range of 29 days–18 years) undergoing dental, maxillo-facial or ENT surgical procedures. These included: (1) dental surgery; (2) maxilla-facial surgery following trauma with fracture; (3) temporo-mandibular surgery; (4) cleft palate and cleft lip repair; (5) ear surgery; (6) endoscopic paranasal cavity surgery and septoplasty; (7) clean head and neck surgery; (8) clean/contaminated head and neck surgery and (9) tonsillectomy and adenoidectomy. Due to the lack of pediatric data for the majority of dental, maxillo-facial and ENT surgeries and the fact that the recommendations for adults are currently used, there is a need for ad hoc studies to be rapidly planned for the most deficient areas. This seems even more urgent for interventions such as those involving the first airways since the different composition of the respiratory microbiota in children compared to adults implies the possibility that surgical antibiotic prophylaxis schemes that are ideal for adults may not be equally effective in children.

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“…Various prophylactic antibiotic regimens for major head and neck oncological procedures have been investigated, and many differing conclusions have been reached regarding optimal choice and duration of chemotherapeutic prophylaxis. (Becker and Parell, 1979;Goode et al, 1979;Becker, 1981;Suarez et al, 1981;Brand et al, 1982;Fee et al, 1984;Panosetti et al, 1987;Johnson and Yu, 1988;Robbins et al, 1988;Saginur et al, 1988;Friberg and Lundberg, 1990;Sawyer et al, 1990). In all cases, the use of prophylactic antibiotic therapy has been shown to reduce the incidence of postoperative infection related wound complications, and has become the standard of care in cleancontaminated head and neck surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

Cephazolin and metronidazole prophylaxis in head and neck surgery

Strauss

Saccogna²,

Allphin³

1997

J. Laryngol. Otol.

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A seven-day course of cephazolin and metronidazole chemoprophylaxis for clean-contaminated head and neck oncological procedures is compared to results with previously published antibiotic regimens. Aetiological factors associated with increased rates of wound complications are analyzed. Retrospective analysis of procedures over asix-year period was performed. The overall wound complication rate was 28.1 per cent, comparing favourably with previously published results. A major fistula was the most common complication with a rate of 9.2 per cent. Factors statistically associated with increased rates of wound complications included: radical neck dissection, extended surgical procedures requiring flap reconstruction, previous tracheotomy, and race. This is the largest single institutional study to show thata seven-day course of cephazolin and metronidazole is an effective chemoprophylactic regimen in head and neck surgery.

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Antimicrobial Prophylaxis in Head and Neck Surgery

Cited by 9 publications

References 10 publications

Evidence‐Based Use of Perioperative Antibiotics in Otolaryngology

Evidence‐Based Use of Perioperative Antibiotics in Otolaryngology

Antimicrobial Prophylaxis in Neonates and Children Undergoing Dental, Maxillo-Facial or Ear-Nose-Throat (ENT) Surgery: A RAND/UCLA Appropriateness Method Consensus Study

Cephazolin and metronidazole prophylaxis in head and neck surgery

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