The Effect of Antibiotic Therapy on Recovery After Tonsillectomy in Children: A Controlled Study

Abstract

\s=b\ Tonsillectomycontinues to be a commonly performed operation in the pediatric age group. The postoperative period is often protracted and characterized by throat and ear pain, intermittent fever, foul odor from the oral cavity, and poor oral intake. Consequently, antibotics are frequently prescribed in an effort to minimize these symptoms and/or avoid complications such as dehydration or secondary infection of the operative site. However, to our knowledge, no study to date has been performed to demonstrate the efficacy of antibiotic therapy in this setting. At the Children's Hospital of Philadelphia, a prospective, randomized, double-blind study was undertaken in which ampicillin (or placebo) was administered intravenously at the time of surgery and for 12 to 24 hours postoperatively. The children then continued to receive oral amoxicillin therapy (or placebo) for an additional seven days. The patients were then evaluated for the incidence and severity of postoperative symptoms and complications. Intraoperative cultures of the oropharynx and tonsillar tissue, as well as cultures of the tonsillar fossa, were obtained following completion of one week of therapy. Our results indicate that ampicillin sodium /amoxicillin trihydrate therapy is well tolerated and safe in the nonallergic child and is effective in minimizing fever and other troublesome postoperative symptoms, such as pain, lassitude, mouth odor, and poor oral intake after tonsillectomy.

Avaliação da antibioticoterapia na morbidade pós-adenotonsilectomia: estudo prospectivo randomizado

“…Pain alleviation may prevent dehydration, mainly among younger children, and consequent hospitalization -often a traumatic experience for children and parents. 4 The patients in our trial did not require any medication other than the prescribed analgesics to manage their pain. Talbot 15 postulates that pain and sialorrhea in the post-op are more related to spasms in the pharyngeal constrictor muscles than to exposure of nerve endings.…”

“…Although antibiotics were deemed beneficial by some studies in relation to post-adenotonsillectomy morbidity 1,4 , one needs to consider the significant prevalence of adverse effects in the patient population 1,16 and, above all, the issue of bacterial resistance to antibiotics and the cost of treatment. Thus, the routine use of amoxicillin in post-adenotonsillectomy patients remains controversial.…”

“…According to Telian et al 4 , the use of antibiotics in the to Collin et al 1 , patients taking antibiotics in the post-op returned one day earlier to their daily routine activities and to oral intake, presenting a statistically significant difference against untreated patients. Telian et al 4 pointed to a reduction in the prevalence, duration, and severity of fever episodes among patients treated post-operatively with antibiotics. These patients were also able to return earlier to their daily routine activities and regular feeding habits.…”

“…In 1980 Telian et al 4 showed the benefits of using ampicillin/amoxicillin in mitigating post-op symptoms such as fever and pain. In 1999 Colreavy looked at post-op pain reduction through the use of analgesics and verified a statistically significant improvement in the group of patients taking amoxicillin + clavulanic acid when compared to those in the control group.…”

Antibiotic following tonsillectomy: are we justified?

“…This is based on early randomized control trials which suggested improved recovery with use of antibiotics. 5 Recent studies suggest that there is no role of antibiotics in reducing post tonsillectomy morbidity. 6 Cochrane review has not found any role of antibiotics in reducing incidence of post tonsillectomy secondary hemorrhage.…”