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

Abstract

BackgroundAdenotonsillectomy results in postoperative morbidity which otolaryngologists attempt to reduce by use of antibiotics. The regimes used as quite varied with some opting for a full oral course postoperatively while others prefer prophylactic doses. This randomised clinical trial done in Kenyatta National Hospital, Kenya had the aim of comparing the efficacy of Co-Amoxiclav given as a single intravenous dose with a full oral course in the prevention of post adenotonsillectomy morbidity.Methods126 patients below 12 years scheduled to undergo adenotonsillectomy were randomised into two groups. 63 were given a single intravenous dose of Enhancin [Co-Amoxiclav] at induction while the remaining half received a five days oral course of the same postoperatively. All received oral Pacimol [Paracetamol] in the postoperative period. Analysis was done and comparison made between the two groups with regards to pain, fever and diet tolerated in the postoperative period with a follow up period of seven days.ResultsThere was no statistical significant difference between the two groups with regards to postoperative pain, fever and diet tolerated. All had a P-value > 0.2. Postoperative pain was highest in the first postoperative day and reduced progressively to the lowest level on the 7th postoperative day. As pain reduced, patients were able to tolerate a more solid diet with all but 6 tolerating their usual diet. 4 patients developed fever in the 1st postoperative day which did not progress to the next day. One patient had fever on the 4th and 7th postoperative day and was admitted in the paediatrics' ward with a chest infection. All these patients with history of fever were in the group that was on oral postoperative Co-Amoxiclav.ConclusionA single intraoperative dose of Co-Amoxiclav given intravenously at induction was found to be just as effective as a full oral course of the same given postoperatively in the prevention of post adenotonsillectomy morbidity. The prophylactic dose is favoured over the later as it is cheaper, ensures compliance and relieves off the need for refrigeration of the oral suspension as not all have access to refrigeration in low economy countries as ours.Trial registrationClinicalTrials.gov: NCT01267942

Evidence‐Based Use of Perioperative Antibiotics in Otolaryngology

“…Similarly, 5 subsequent RCTs 12‐16 (combined n = 440) and 2 prospective cohort studies 17,18 (combined n = 158) found intraoperative IV and postoperative oral antibiotics to reduce fever, odor from the oral cavity, pain, bleeding, and/or days until return of baseline oral intake. When used, a 5‐day or 7‐day course of antibiotics has no advantage over either a single intraoperative dose or a 3‐day course of antibiotics 13,19‐21 . In addition, preoperative oral antibiotics do not add benefit when compared to intraoperative and postoperative dosing 22 .…”

“…When used, a 5-day or 7-day course of antibiotics has no advantage over either a single intraoperative dose or a 3-day course of antibiotics. 13,[19][20][21] In addition, preoperative oral antibiotics do not add benefit when compared to intraoperative and postoperative dosing. 22 Five RCTs [23][24][25][26][27][28] (combined n = 577), two prospective cohort studies 29 (combine n = 95), and 3 retrospective cohort studies [30][31][32] (combined n = 215) were unable to show advantages of intraoperative or postoperative antibiotics in adenoidectomies or tonsillectomies.…”

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.…”

Role of honey after tonsillectomy: a systematic review and meta‐analysis of randomised controlled trials

“…Use of antibiotics may improve infection, which may decrease fever and inflammation. Improvement of inflammation may decrease haemorrhage, pain, resumption of normal diet and recovery after tonsillectomy . Due to this, the combined use of antibiotics with honey could have produced favourable outcome than honey alone in our systematic review.…”