The effect of topical antibiotic therapy on recovery after tonsillectomy in adults

Mann, Eric A.; Blair, Elizabeth A.; Levy, Alan J.; Chang, Audrey S.

doi:10.1016/s0194-5998(97)80060-5

Cited by 13 publications

(41 citation statements)

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“…The role of antibiotics in reducing post-tonsillectomy pain has been considered in more studies but with contradictory results. Cannon 9 and Mann et al 10 found systemic antibiotics gave no signi cant pain relief, but one used a single dose regimen and the other was based on a very small number of patients. Grandis et al 11 and Linder et al 12 found perioperative antibiotics gave some pain relief in adults; similar results were obtained in children by Colreavy et al 13 and Telian et al 14 Within our own department audit has regularly shown secondary haemorrhage to be a common and occasionally dangerous complication of adult tonsillectomy.…”

Section: Introductionmentioning

confidence: 99%

Is the routine use of antibiotics justified in adult tonsillectomy?

et al. 2003

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Pain and secondary haemorrhage are the commonest complications of adult tonsillectomy, occurring mostly in the community. This is a randomized, double-blind, placebo-controlled, prospective trial of the effect of perioperative amoxycillin on these complications. The incidence and severity of post-operative haemorrhage was measured. For the first 10 post-operative days patients provided a linear pain score, a record of GP visits, and their use of additional antibiotics and analgesics. Of 95 patients considered: 23 suffered a secondary haemorrhage; 54 consulted their general practitioner (GP) because of pain; additional antibiotics were used by at least 31 and additional analgesics by at least 41. No significant differences were demonstrated between the active and placebo groups for any of these measures. This study demonstrates that secondary haemorrhage is common after adult tonsillectomy. Post-operative pain remains a major problem requiring frequent GP consultations. There appears to be no justification for the routine use of perioperative antibiotics.

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Section: Introductionmentioning

confidence: 99%

Is the routine use of antibiotics justified in adult tonsillectomy?

et al. 2003

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“…Level I evidence exists to illustrate the superiority of antibiotic prophylaxis over placebo in clean‐contaminated head and neck procedures, where incisions through the oral or pharyngeal mucosa 4,5 . With regard to their use in tonsillectomy specifically, there is level I evidence to support antibiotic prophylaxis use in reducing the incidence of fever, oropharyngeal pain, oral cavity odour and the time interval in returning to normal activity 6,7 …”

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confidence: 99%

“…: +353 86 818 8811; fax: +353 1 824 9610; e-mail: brendanfennessy@yahoo.com incidence of fever, oropharyngeal pain, oral cavity odour and the time interval in returning to normal activity. 6,7 While there are no studies written in English that specifically address prophylaxis in thyroidectomy, submandibular gland excision and parotidectomy, these procedures are among several incorporated into two retrospective cohort studies, 8,9 which concluded that prophylaxis failed to reduce wound infection rates in patients undergoing clean procedures of the head and neck (level II evidence).…”

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confidence: 99%

Antimicrobial prophylaxis in otorhinolaryngology/head and neck surgery

Fennessy

Harney

O’Sullivan

et al. 2007

Clinical Otolaryngology

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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.

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“…Several studies published in recent years have shown no benefit to patients by prophylactic antibiotics following tonsillectomy 9–11 . However, in one study it was reported that topical antibiotic therapy following tonsillectomy resulted in a reduction in oral bacterial counts and postoperative morbidity including pain in adult patients 12 . We feel that there is insufficient evidence to support routine use of prophylactic antibiotics following these procedures.…”

Section: Discussionmentioning

confidence: 93%

Anticipated absence from work ('sick leave') following routine ENT surgery: are we giving the correct advice? A postal questionnaire survey

2001

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In the UK patients who undergo common ear, nose and throat (ENT) operations, and are employed, are advised to take 2 weeks sick leave before returning to their employment. A retrospective postal questionnaire survey (of adult patients who had undergone four common specific ENT operations) was conducted, to validate whether this preoperative advice given, was appropriate, and to attempt to assess the patient factors, which influenced the amount of postoperative absence from work. Among 218 questionnaires sent, 156 (71.6%) responses were returned and 132 (60.6%) were used. Analysis of the data for absence from work, showed that 58.3% had taken 2 weeks. The majority of patients (70.5%) stated that 2 weeks absence following their surgery was appropriate, whereas 5.3% reported that the period was excessive and 24.2% felt that it was inadequate. Postoperative pain (30.3%), infection (30.3%), bleeding (7.6%) and other causes (15.2%) were reported as the reasons for the delay to return to work. Nearly 31% of men and 55% of women had taken > 2 weeks of sick leave. In conclusion, the current practice of advising employed adults to take 2 weeks time off work following routine ENT surgery is appropriate. However, nearly 42% had taken > 2 weeks to return to their employment. Patients who underwent tonsillectomy and laser palatoplasty in general, required more time to recuperate prior to returning to work, when compared to those who had undergone septoplasty and functional endoscopic sinus surgery (FESS). Postoperative pain and infection were reported to be the main reasons for the delay in returning to work. Men, and self-employed patients returned to work earlier than women and other employed groups.

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The effect of topical antibiotic therapy on recovery after tonsillectomy in adults

Cited by 13 publications

References 0 publications

Is the routine use of antibiotics justified in adult tonsillectomy?

Is the routine use of antibiotics justified in adult tonsillectomy?

Antimicrobial prophylaxis in otorhinolaryngology/head and neck surgery

Anticipated absence from work ('sick leave') following routine ENT surgery: are we giving the correct advice? A postal questionnaire survey

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