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

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

Abstract

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.

Keywords

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

References

  1. 1.
    Weber RS, Callender DL. Antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery. Ann Otol Rhinol Laryngol Suppl. 1992;55:16–20.CrossRefGoogle Scholar
  2. 2.
    Dor P, Lastersky J. Prophylactic antibiotics in oral, pharyngeal, and laryngeal surgery for cancer: a double-blind study. Laryngoscope. 1973;83:1992–8.CrossRefGoogle Scholar
  3. 3.
    Johnson JT, Myers EN, Thearle PB. Antimicrobial prophylaxis for contaminated head and neck surgery. Laryngoscope. 1984;94:46–51.CrossRefGoogle Scholar
  4. 4.
    Raine CH, Bartzokas CA, Stell PM. Chemoprophylaxis in major head and neck surgery. J R Soc Med. 1984;77:1006–9.CrossRefGoogle Scholar
  5. 5.
    Sift AC. Wound sepsis, chemoprophylaxis and major head and neck surgery. Clin Otolaryngol Allied Sci. 1988;13:81–3.CrossRefGoogle Scholar
  6. 6.
    Piccart M, Dor P, Klastersky J. Antimicrobial prophylaxis of infections in head and neck cancer surgery. Scand J Infect Dis Suppl. 1983;39:92–6.PubMedGoogle Scholar
  7. 7.
    Johnson JT, Schuller DE, Silver F. Antibiotic prophylaxis in high-risk head and neck surgery: one-day vs. five-day therapy. Otolaryngol Head Neck Surg. 1986;95(5):554–7.CrossRefGoogle Scholar
  8. 8.
    Johnson JT, Yu VL. Antibiotic use during major head and neck surgery. Ann Surg. 1988;207(1):108–11.CrossRefGoogle Scholar
  9. 9.
    Gerard M, Meunier F, Dor P. Antimicrobial prophylaxis for major head and neck surgery in cancer patients. Antimicrob Agents Chemother. 1988;32(10):1557–9.CrossRefGoogle Scholar
  10. 10.
    Weber RS, Raad I, Frankenthaler R. Ampicillin-sulbactam vs clindamycin in head and neck oncologic surgery: the need for gram-negative coverage. Arch Otolaryngol Head Neck Surg. 1992;118(11):1159–63.CrossRefGoogle Scholar
  11. 11.
    Mustafa E, Tahsin A. Cefotaxime prophylaxis in major non-contaminated head and neck surgery: one-day vs. seven-day therapy. J Laryngol Otol. 1993;107(1):30–2.CrossRefGoogle Scholar
  12. 12.
    Rodrigo JP, Alvarez JC, Gomez JR, et al. Comparison of three prophylactic antibiotic regimens in clean-contaminated head and neck surgery. Head Neck. 1997;19(3):188–93.CrossRefGoogle Scholar
  13. 13.
    Carroll WR, Rosenstiel D, Fix JR. Three-dose vs extended-course clindamycin prophylaxis for free-flap reconstruction of the head and neck. Arch Otolaryngol Head Neck Surg. 2003;129(7):771–4.CrossRefGoogle Scholar
  14. 14.
    Skitarelic N, Morovic M, Manestar D. Antibiotic prophylaxis in clean-contaminated head and neck oncological surgery. J Craniomaxillofac Surg. 2007;35(1):15–20.Google Scholar
  15. 15.
    Liu SA, Tung KC, Shiao JY. Preliminary report of associated factors in wound infection after major head and neck neoplasm operations—does the duration of prophylactic antibiotic matter? J Laryngol Otol. 2008;122(4):403–8.CrossRefGoogle Scholar
  16. 16.
    Sepehr A, Santos BJ, Chou C. Antibiotics in head and neck surgery in the setting of malnutrition, tracheotomy, and diabetes. Laryngoscope. 2009;119(3):549–53.CrossRefGoogle Scholar
  17. 17.
    Mitchell RM, Mendez E, Schmitt NC. Antibiotic prophylaxis in patients undergoing head and neck free flap reconstruction. JAMA Otolaryngol Head Neck Surg. 2015;141(12):1096–103.CrossRefGoogle Scholar
  18. 18.
    Langerman A, Ham SA, Pisano J. Laryngectomy complications are associated with perioperative antibiotic choice. Otolaryngol Head Neck Surg. 2015;153(1):60–8.CrossRefGoogle Scholar
  19. 19.
    Langerman A, Thisted R, Hohmann S. Antibiotic and duration of perioperative prophylaxis predicts surgical site infection in head and neck surgery. Otolaryngol Head Neck Surg. 2016;154(6):1054–63.CrossRefGoogle Scholar
  20. 20.
    Pool C, Kass J, Spivack J. Increased surgical site infection rates following clindamycin use in head and neck free tissue transfer. Otolaryngol Head Neck Surg. 2016;154(2):272–8.CrossRefGoogle Scholar
  21. 21.
    Cohen LE, Finnerty BM. Perioperative antibiotics in the setting of oropharyngeal reconstruction. Ann Plast Surg. 2016;76(6):663–7.CrossRefGoogle Scholar
  22. 22.
    Bartella AK, Kamal M, Teichmann J. Prospective comparison of perioperative antibiotic management protocols in oncological head and neck surgery. J Craniomaxillofac Surg. 2017;45(7):1078–82.CrossRefGoogle Scholar
  23. 23.
    Berrío-Torres SI, Umscheid CA, Bratzler DW. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784–91.CrossRefGoogle Scholar
  24. 24.
    Bratzler DW, Dellinger EP, Olsen KM. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195–283.CrossRefGoogle Scholar
  25. 25.
    Vila PM, Zenga J, Jackson RS. Antibiotic prophylaxis in clean-contaminated head and neck surgery: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2017;157(4):580–8.CrossRefGoogle Scholar
  26. 26.
    Shin JJ, Johnson JT. Chapter 27A: One-day versus longer-course perioperative antibiotics: impact on postoperative surgical-site infections. In: Evidence-based otolaryngology. 1st ed. New York: Springer Science+Business Media, LLC; 2008. p. 587–98.CrossRefGoogle Scholar
  27. 27.
    Saunders S, Reese S, Lam J. Extended use of perioperative antibiotics in head and neck microvascular reconstruction. Am J Otolaryngol. 2017;38(2):204–7.CrossRefGoogle Scholar
  28. 28.
    Khariwala SS, Le B, Pierce B. Antibiotic use after free tissue reconstruction of head and neck defects: short course vs. long course. Surg Infect. 2016;17(1):100–5.CrossRefGoogle Scholar
  29. 29.
    Busch CJ, Knecht R, Münscher A. Postoperative antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery: a retrospective cohort study. Eur Arch Otorhinolaryngol. 2016;273(9):2805–11.CrossRefGoogle Scholar
  30. 30.
    Pichichero ME, Casey JR. Safe use of selected cephalosporins in penicillin-allergic patients: a meta-analysis. Otolaryngol Head Neck Surg. 2007;136(3):340–7.CrossRefGoogle Scholar
  31. 31.
    Annè S, Reisman RE. Risk of administering cephalosporin antibiotics to patients with histories of penicillin allergy. Ann Allergy Asthma Immunol. 1996;74(2):167–70.Google Scholar

Copyright information

© 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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