Perioperative Antibiotic in Adenoidectomy with Partial Tonsillectomy: A Randomized Trial

Abstract

Objectives: To examine potential benefits of perioperative antibiotic therapy in children undergoing adenotonsillotomy. Methods: Adenoidectomy with tonsillotomy was performed in 124 children with obstructive symptoms, aged 5–7 years. Of these, 120 completed the study. Intraoperative intravenous and postoperative oral clindamycin, or placebo for 7 days, were administered. Results: There were significant differences between the groups regarding pain intensity (p < 0.001) and duration (p < 0.05), day of return to normal physical activity (p < 0.05), occurrence and duration of oral malodor (p < 0.001), number of doses of additional analgesic (p < 0.001), healing grading (p < 0.05) and parents’/caregivers’ satisfaction scores on the 4th postoperative day. There were indications for antibiotic in 2 individuals in the placebo group. Conclusions: There are significant differences in the course of convalescence related to perioperative antibiotic in children after adenotonsillotomy, but strict indications for antibiotics in these patients are rare.

PROSPECT guideline for tonsillectomy: systematic review and procedure‐specific postoperative pain management recommendations

“…Eight eligible studies [126][127][128][129][130][131][132][133] reported inconclusive pain outcomes with the use of antibiotics. In studies reporting an analgesic effect, two tested antibiotic mouth wash.…”

The Efficacy of Perioperative Antibiotic Therapy in Tonsillectomy Patients

“…Nevertheless, the authors considered this finding beneficial, stating that even transient reduction of pain promotes a return to a normal diet, and thus to resuming the activities of daily living [16,41]. Zagóls-ki and Kulisiewicz studied 124 children undergoing tonsillectomy and found that those who received antibiotic prophylaxis experienced reduced intensity and duration of postoperative pain, required fewer additional doses of analgesics and returned earlier to normal physical activities [42]. Moreover, the administration of antibiotic therapy was associated with a lower prevalence and shorter duration of mouth odor, and most importantly, with faster healing and greater satisfaction on the part of the patients' parents.…”

“…Despite these positive outcomes, the authors highlighted the potential risk of complications related to antibiotic therapy. Therefore, they recommended that patients or their caregivers should be informed of the potential benefits and risks of antibiotic prophylaxis, and should participate in the decision-making process regarding its implementation [42,43].…”

Adult Tonsillectomy: Anatomical Differences Affect Postoperative Transient Hypernasality

“…Each patient's pharynx was also examined to assess healing and rated on a 5-point scale: 4 - redness and edema of vast regions of pharyngeal mucosa, including the uvula; 3 - edema of the uvula with or without redness and/or edema of anterior pillar mucosa; 2 - redness and edema of peritonsillar tissues excluding the uvula; 1 - redness of anterior pillar mucosa without edema, and 0 - normal mucosa, without redness or edema [20]. Edema of the uvula is an important factor of healing due to its symptoms: pain-causing dysphagia as well as dyspnea [20]. …”