Is Antibiotic Therapy Warranted in Clean-Contaminated Head and Neck Surgery Beyond 24 h?

  • Jessica Yesensky
  • Palmila Liu
  • Louis PortugalEmail author
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


Antibiotic prophylaxis in head and neck surgery aims to prevent post-operative surgical site infections. While various studies have looked at the effectiveness of perioperative antibiotics delivered in clean-contaminated head and procedures, there remains a lack of consensus on the most effective choice and duration of delivery of antibiotics in preventing post-operative infections. This chapter explores and evaluates the literature regarding antibiotic prophylaxis in clean-contaminated head and neck surgery cases including those in which microvascular free-flap reconstruction was used. Each study was reviewed for its quality of evidence in determining the necessity of antibiotic therapy beyond 24 h in clean-contaminated head and neck surgery. The majority of studies were randomized controlled trials with additional retrospective reviews. Overall, short duration of antibiotics (<24 h) are as effective as long durations (>24 h) and avoid unnecessary antibiotic exposure in patients undergoing clean-contaminated head and neck surgery with or without free-flap reconstruction. Additionally, post-operative prophylaxis with clindamycin should be avoided because of its association with increased rates of surgical site infection and antibiotic-induced complications.


Antibiotic prophylaxis Head and neck surgery Clean-contaminated surgery Surgical site infection 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Otolaryngology/Head and Neck SurgeryThe University of ChicagoChicagoUSA
  2. 2.Pritzker School of MedicineThe University of ChicagoChicagoUSA

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