Surgical prophylaxis for head and neck surgery
Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis). See Head and neck procedures and their requirement for surgical antibiotic prophylaxis for the recommendations for surgical prophylaxis for head and neck surgery.
For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.
|
Procedures |
Is surgical antibiotic prophylaxis indicated? |
|---|---|
|
thyroidectomy simple lymph node excision (including submandibular lymph node excision) parotidectomy clean procedures (see Centers for Disease Control and Prevention stratification of surgical wounds) not listed below |
NO |
|
procedures involving insertion of prosthetic material clean–contaminated procedures (see Centers for Disease Control and Prevention stratification of surgical wounds) not listed above extensive neck dissection for malignancy debulking or reconstructive surgery for malignancy |
YES [NB1] |
Note:
NB1: Although a single preoperative dose of surgical antibiotic prophylaxis is expected to be sufficient to prevent postoperative infection following extensive neck dissection for malignancy, and debulking or reconstructive surgery for malignancy, there is insufficient evidence to show that a single dose of prophylaxis is as effective as 24 hours of prophylaxis. Postoperative doses can be considered but prophylaxis (intravenous or oral) should not continue beyond 24 hours. | |
If prophylaxis is indicated for head and neck procedures, use:
cefazolin 2 g (child: 30 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed1 surgical prophylaxis, head and neck cefazolin
PLUS for incisions through mucosal surfaces
metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, within the 120 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed1. surgical prophylaxis, head and neck metronidazole
Intravenous amoxicillin+clavulanate has been used as a single drug for prophylaxis for extensive neck dissection for malignancy, and debulking or reconstructive surgery for malignancy. However, the combination of cefazolin and metronidazole is preferred because of its narrower spectrum of activity.
For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, use cefazolin, with or without metronidazole, as above. See also Surgical antibiotic prophylaxis for patients with a penicillin or cephalosporin allergy.
For patients with immediate severe or delayed severe hypersensitivity to penicillins, use:
clindamycin 600 mg (child: 15 mg/kg up to 600 mg) intravenously, within the 120 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed1 surgical prophylaxis, head and neck clindamycin
PLUS for extensive neck dissection, or debulking or reconstructive surgery
gentamicin (adult and child) 2 mg/kg up to 180 mg intravenously over 3 to 5 minutes, within the 120 minutes before surgical incision23; intraoperative redosing is unlikely to be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, head and neck gentamicin