Antimicrobial prophylaxis in otorhinolaryngology/head and neck surgery

Abstract

Prophylactic antimicrobial therapy is defined as the administration of an antimicrobial agent prior to contamination of previously sterile tissues or fluids, in an attempt to reduce the microbial burden of intraoperative contamination. Prophylactic antimicrobial therapy should cover the anticipated floral contamination, with therapeutic levels from incision to closure. There is level I evidence to support the use of prophylaxis in clean-contaminated head and neck procedures and tonsillectomy, while level II evidence fails to support the use of prophylaxis in clean head and neck procedures. The aim of this study was to evaluate the use, timing and appropriateness of antimicrobial prophylaxis perioperatively, in otorhinolaryngological/head and neck procedures. A total of 34/51 (66%) patients were administered antimicrobial agents prophylactically. Six of 19 patients (42%) who ought to have received prophylaxis did not, while six of 13 (46%) of those who did not require it received it. Administration was unsuitably timed in 14 of 34 (41%) operations. This study demonstrates unnecessary administration of antimicrobial agents perioperatively, subclinical intraoperative antimicrobial levels for prophylaxis and inconsistent documentation regarding prophylaxis in otorhinolaryngological/head and neck procedures in a general ENT unit.

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…Similar results were reported in several additional small, uncontrolled studies. 500,[527][528][529] Choice of agent. Several randomized, single-center studies have compared antimicrobial regimens for clean-contaminated procedures.…”

Single intraoperative intravenous Co-Amoxiclav versus postoperative full oral course in prevention of postadenotonsillectomy morbidity: a randomised clinical trial

“…They didn't consider postoperative fever in their study. Fennesby B.G et al found level 1 evidence that antibiotics reduce the incidence of postoperative fever, oropharyngeal pain and return to normal activity post tonsillectomy [12]. The authors had done literature review through Pubmed in an attempt to identify the level of evidence for or against the use of prophylaxis for various ear, nose and throat surgeries.…”

Evidence and evidence gaps of laryngeal cancer surgery

“…Some randomized controlled trials on tumor surgery of the neck could show a higher infection rate after placebo administration compared to antibiotic prophylaxis [246], [247], [248]. The incidence of wound infection after clean-contaminated oncological interventions in the head and neck area without administration of perioperative antibiotic prophylaxis amounts to 30-80% depending on the patient groups [249], [250].…”