To Give or Not to Give? Prescribing Antibiotics to the Tonsillectomy Patients in a Tertiary Care Setting

Abstract

IntroductionAdeno-tonsillectomy is one of the most common procedures performed worldwide in pediatric age group. Antibiotics use after tonsillectomy is like any other surgical procedure; and it is thought that the antibiotic use may help to reduce post-operative morbidity. Giving antibiotics in tonsillectomy patients is a common practice for decades but recently there has been a paradigm shift towards not using the antibiotics, especially in the pediatric population. MethodsA prospective study was done on a cohort of 123 patients and they were divided into two groups on the basis of choice to receive or not to receive antibiotics after tonsillectomy, and these patients were followed in post-operative period to see any differences in the rate of complications. ResultsNo significant statistical correlation was found between age, gender or post-operative visits and postoperative complications in between the two groups. Half of the patients received antibiotics; however, the use of antibiotics did not show a significant decrease in post-operative complications. ConclusionRegular use of antibiotics in post-tonsillectomy patients should not be advised as the use of antibiotics do not prevent or reduce post-operative complications in tonsillectomy patients.

The Use of Postoperative Antibiotics in Tonsillectomy: A Comparative Study

“…This agree with Padia et al [25] who reported that the use of antibiotics (especially oral antibiotics may lead to gastric upsets, nausea, vomiting, and allergic reactions in IV antibiotics) have unwarranted side effects, and disagree with Junaid et al [6] , who found that the patients receiving oral antibiotics did not complain of any drug-related adverse reaction, and relay this on the possibility that most of the patients have been prescribed in the past, multiple antibiotics for their recurrent tonsil infection and hence they tolerated it well.…”

“…As a result, the issue is still up for debate. Additionally, although subsequent haemorrhage is typically linked to infection and treated with antibiotics in such individuals, it is unknown if there is a causative link and whether the risk is decreased [6] .…”

Multicentre clinical study of haemorrhage after coblation tonsillectomy in children: a prospective study protocol

“…Junaid et al reported that regular use of antibiotics in post-tonsillectomy patients does not prevent or reduce postoperative complications. 18 …”

“…The main risk factors that may affect haemorrhage rates after CTE will be collected in this study. [9][10][11][12][13][14][15][16][17][18][19][20] Risk factors due to the patient's own condition include, gender, age, body mass index, education status of the primary guardian, date of symptoms onset, parameters of polysomnography, concomitant symptoms other than sleep disorders, history of other systemic diseases, tonsil size, adenoid size, etc. Risk factors due to surgical intervention include surgery date, surgery time, intraoperative blood loss, use of suture haemostasis technique, use of medicine during anaesthesia, brand and model of plasma radiofrequency used in the operation, etc.…”

“…With 25-30 variables potentially associated with bleeding rates after tonsillectomy in children, [9][10][11][12][13][14][15][16][17][18][19][20] mentioned in the Data collection section, the minimum sample size required is approximately 250-300 bleeding patients to avoid violating the principle of approximately 10 outcome events (ie, bleeding) per variable in the regression. 24 According to reports in the literature on the incidence of PTH, 3 a lower incidence of 1.5% was chosen as the estimated incidence of PTH to ensure adequate enrolment of patients with postoperative bleeding.…”