Shorter-Duration Antibiotic Prophylaxis Prevents Wound Infections After ENT Surgery

By Will Boggs MD

June 05, 2019

NEW YORK (Reuters Health) - Antibiotic-prophylaxis durations of 24 hours or less are as effective as durations of 72 hours or more for preventing surgical-site infections (SSIs) after ear, nose, throat (ENT) and oral and maxillofacial (OMF) surgery, according to a new systematic review and meta-analysis.

"In an era of antibiotic resistance, we need to use these lifesaving drugs for those who need them only," said Dr. Heiman F. L. Wertheim from Radboud University Medical Center, in Nijmegen, the Netherlands.

"Extended prophylaxis is a waste," he told Reuters Health by email. "It is common for these types of surgeries to give 5 days of antibiotics. A single dose is enough, so you can reduce antibiotics by ~80% for most interventions!"

Most guidelines favor short-course postoperative antibiotic prophylaxis over prolonged prophylaxis, because little or no additional anti-infective benefits have been observed after prolonging the postoperative antibiotic prophylaxis.

There is little evidence, however, on the postoperative use of antimicrobial prophylaxis in ENT and OMF surgery, Dr. Wertheim's team note in JAMA Otolaryngology-Head and Neck Surgery, online May 9.

The researchers examined the association of SSIs with use of short-course versus extended-course antibiotic prophylaxis after ENT and OMF surgery in 21 prospective trials with a total of 1,974 participants.

The pooled risk ratio of SSI for short-course regimens versus extended-course regimens was 0.90 with a 95% confidence interval of 0.67-1.19, confirming the lack of difference between the regiments. Similar results were obtained when ENT and OMF operations were analyzed separately.

In nine studies that reported on adverse events, extended-course prophylaxis was associated with a 2.40-fold increased risk of adverse events, compared with short-course prophylaxis, a significant difference.

Similarly, extended-course prophylaxis was associated with a significantly greater risk of distant adverse events (i.e., not surgical-site issues) compared with short-course prophylaxis (relative risk, 2.31; 95% confidence interval, 1.43 to 3.73).

Extended-course prophylaxis was also associated with significantly longer mean hospital stay in one study and with significantly higher treatment costs per participant in another.

"Take action, review your policies, and take out extended prophylaxis where there is no evidence that it is of any use," Dr. Wertheim said.


JAMA Otolaryngol Head Neck Surg 2019.