General principles and indications
Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis). See Ear, nose and throat procedures and their requirement for surgical antibiotic prophylaxis for the recommendations for surgical prophylaxis for ear, nose and throat surgery.
The role of topical antibiotic prophylaxis for insertion of tympanostomy tubes (grommets) is controversial. There is insufficient evidence to recommend routine use of topical antimicrobial therapy.
Antibiotic prophylaxis should not be given to patients with nasal packing or a tamponade device in situ following epistaxis.
For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.
|
Procedure |
Is surgical antibiotic prophylaxis indicated? |
|---|---|
|
uncomplicated nose or sinus surgery (including endoscopic procedures) uncomplicated ear surgery otoplasty stapedectomy tonsillectomy adenoidectomy |
NO [NB1] |
|
major ear surgery complex septorhinoplasty revision sinus surgery laryngectomy (primary or salvage) tympanomastoid surgery hearing implant procedures, including cochlear implant procedures |
YES [NB2] |
Note:
NB1: Although surgical antibiotic prophylaxis is not required for tonsillectomy or adenoidectomy, patients with specific cardiac conditions (see here) who are undergoing these procedures require antibiotics for the prevention of endocarditis—see Endocarditis prophylaxis for respiratory tract or ear, nose and throat procedures. NB2: Although a single preoperative dose of surgical antibiotic prophylaxis is expected to be sufficient to prevent postoperative infection following laryngectomy, there is insufficient evidence (especially for salvage laryngectomy) 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. | |