The Efficacy of Cefaclor vs Amoxicillin on Recovery After Tonsillectomy in Children

Abstract

Tonsillectomy and adenoidectomy continues to be one of the most commonly performed operations in the pediatric age group. The morbidity from tonsillectomy can be severe and includes throat and ear pain, fever, lethargy, and poor oral intake. A previous study at the Children's Hospital of Philadelphia (Pa) demonstrated the efficacy of amoxicillin therapy in minimizing some of these postoperative symptoms. However, some children continue to have a prolonged recovery even while receiving this antibiotic regimen. Because of these children and the high incidence of Staphylococcus found in tonsillar core tissue, a randomized, prospective study was undertaken at the Children's Hospital of Philadelphia to evaluate the efficacy of cefaclor vs amoxicillin in patients recovering from tonsillectomy. The patients received either ampicillin or cefazolin intravenously at the time of surgery and for 12 to 24 hours postoperatively. When oral intake was adequate, they received either amoxicillin or cefaclor orally for 7 additional postoperative days. Intraoperative cultures of the oropharynx and tonsillar tissue were obtained, as well as cultures of the tonsillar fossa 7 to 14 days postoperatively. The patients were evaluated for severity and duration of postoperative symptoms as well as complications. The results of this study showed no difference between the two groups of patients. We conclude that there is no justification for routine use of cefaclor over amoxicillin in the posttonsillectomy patient.

Antibiotics to Improve Recovery Following Tonsillectomy: A Systematic Review

“…Twenty‐two trials evaluating the role of intraoperative and/or postoperative antibiotics in reducing morbidity following tonsillectomy were identified by the systematic search. The following were excluded from the review: 4 uncontrolled 12–15 and 3 nonrandomized controlled 16–18 trials, 3 trials examining topical antibiotics, 19–21 and 2 trials with inappropriate control groups (1 compared antibiotic vs another antibiotic, 22 1 compared systemic vs topical antibiotic 23 ). Also excluded were 4 randomized controlled, non‐blinded trials 4,24–26 .…”

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

“…Adenotonsillectomy still remains as one of the most frequent surgical procedures done in the pediatric population 2 . Morbidity in the post-op is mostly due to pain, fever, vomiting, bleeding, and fatigue, to name a few 5 .…”

Antibiotics for Reduction of Posttonsillectomy Morbidity: A Meta-Analysis

“…The studies were reviewed in full, and seven of the studies qualified for inclusion (Table I), 2–8 and four studies were excluded (Table II). 9–12 A total of four studies 3–6 qualified for analysis of postoperative pain, three studies 2,3,7 qualified for time to return to normal diet, and two studies 2,7 qualified for time to return to normal activity (Table III). Three studies could not be included in the analysis of the postoperative pain end point, 2,7,8 four studies for analysis of the time to return to normal diet end point, 4–6,8 and five studies for analysis of the time to return to normal activity end point 3–6,8 because of varied outcome measures, outcomes not part of the study, or outcomes not reported (Table III).…”