ENT Surgery

ENT Surgery - Guideline for Antimicrobial Prophylaxis

Publication: 01/01/2009

Next review: 09/03/2025

Clinical Guideline

CURRENT

ID: 1467

Approved By: Improving Antimicrobial Prescribing Group

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

GUIDELINE FOR ANTIMICROBIAL PROPHYLAXIS DURING ENT SURGERY

RECOMMENDED ROUTINE PROPHYLAXIS OPTIONS

For many ENT procedures there is no evidence that antimicrobial prophylaxis is of benefit to patients and its use is therefore not recommended. These guidelines should be applicable to the majority of patients but where the recommendations in these guidelines do not seem appropriate for a particular patient, the surgeon is advised to discuss the case with a Microbiologist

Procedure or situation	Antimicrobial dose/route Give within 2 hours of incision/procedure unless otherwise stated
Procedure or situation	Routine	MRSA Risk and/or penicillin allergy
Routine Ear surgery	Not recommended	Not recommended
Complex Ear Surgery	Co-Amoxiclav 1.2g IV single dose	Teicoplanin 400mg IV single dose
Routine nose, sinus and endoscopic sinus surgery or nasendoscopy	Not recommended	Not recommended
Complex septorhinoplasty	Co-Amoxiclav 1.2g IV single dose	Teicoplanin 400mg IV single dose
Tonsillectomy	Not recommended	Not recommended
Adenoidectomy	Not recommended	Not recommended
Grommet insertion (if bleeding or purulence present)	Topical framycetin sulphate single dose	Topical framycetin sulphate single dose
Head and Neck surgery (clean, benign lesion)	Not recommended	Not recommended
Head and neck surgery (malignant lesions, neck dissection, contaminated)	Co-Amoxiclav 1.2g IV single dose and two further doses 8 hours apart	Teicoplanin 400mg IV single dose
Endocarditis risk¹	Only if active infection at site of operation: Discuss with Microbiology	Only if active infection at site of operation: Discuss with Microbiology

FOOTNOTES

Specific prophylaxis for patients at increased risk of developing endocarditis is no longer recommended. However, localised infections in patients at increased risk of endocarditis should be investigated (with microbiological sampling as appropriate) and treated promptly. If a patient at increased risk of endocarditis has active infection they should ideally be commenced on appropriate antimicrobial therapy prior to an ENT procedure at the site of infection.

Provenance

Record:	1467
Objective:	The aim of antimicrobial prophylaxis in ENT surgery is a reduction in surgical site infection.
Clinical condition:	Antimicrobial prophylaxis during ENT surgery
Target patient group:	Adults
Target professional group(s):	Secondary Care Doctors Pharmacists
Adapted from:

Evidence base

Verschuur HP, de Wever WW, van Benthem PP. Antibiotic prophylaxis in clean and clean-contaminated ear surgery. Cochrane database of systematic reviews (Online). 2004(3):CD003996.
Annys E, Jorissen M. Short term effects of antibiotics (Zinnat) after endoscopic sinus surgery. Acta Otorhinolaryngol Belg. 2000;54(1):23-8.
Andrews PJ, East CA, Jayaraj SM, Badia L, Panagamuwa C, Harding L. Prophylactic vs postoperative antibiotic use in complex septorhinoplasty surgery: a prospective, randomized, single-blind trial comparing efficacy. Arch Facial Plast Surg. 2006 Mar-Apr;8(2):84-7.
Sanchez-Carrion S, Prim MP, De Diego JI, Sastre N, Pena-Garcia P. Utility of prophylactic antibiotics in pediatric adenoidectomy. International journal of pediatric otorhinolaryngology. 2006 Jul;70(7):1275-81.
Kocaturk S, Yardimci S, Yildirim A, Incesulu A. Preventive therapy for postoperative purulent otorrhea after ventilation tube insertion. Am J Otolaryngol. 2005 Mar-Apr;26(2):123-7.
Nawasreh O, Al-Wedyan IA. Prophylactic ciprofloxacin drops after tympanostomy tube insertion. Saudi Med J. 2004 Jan;25(1):38-40.
Zipfel TE, Wood WE, Street DF, Wulffman J, Tipirneni A, Frey C, et al. The effect of topical ciprofloxacin on postoperative otorrhea after tympanostomy tube insertion. Am J Otol. 1999 Jul;20(4):416-20.
Becker GD, Parell GJ. Cefazolin prophylaxis in head and neck cancer surgery. The Annals of otology, rhinology, and laryngology. 1979 Mar-Apr;88(2 Pt 1):183-6.
Dor P, Klastersky J. Prophylactic antibiotics in oral, pharyngeal and laryngeal surgery for cancer: (a double-blind study). The Laryngoscope. 1973 Dec;83(12):1992-8.
Johnson JT, Myers EN, Thearle PB, Sigler BA, Schramm VL, Jr. Antimicrobial prophylaxis for contaminated head and neck surgery. The Laryngoscope. 1984 Jan;94(1):46-51.
Johnson JT, Yu VL, Myers EN, Muder RR, Thearle PB, Diven WF. Efficacy of two third-generation cephalosporins in prophylaxis for head and neck surgery. Arch Otolaryngol. 1984 Apr;110(4):224-7.
Velanovich V. A meta-analysis of prophylactic antibiotics in head and neck surgery. Plast Reconstr Surg. 1991 Mar;87(3):429-34; discussion 35.
Coskun H, Erisen L, Basut O. Factors affecting wound infection rates in head and neck surgery. Otolaryngol Head Neck Surg. 2000 Sep;123(3):328-33.
Surgical site infections: prevention and treatment Clinical guideline [CG74] Published date: October 2008 Last updated: February 2017
SIGN. Antibiotic Prophylaxis in Surgery. Scottish Intercollegiate Guideline Network Publication Number 104. Edinburgh; 2008 update April 2014.
Priyesh Patel, Asitha Jayawardena, Rachel Walden, Edward Penn, David Francis, Evidence-Based Use of Perioperative Antibiotics in OtolaryngologyOtolaryngology–Head and Neck Surgery 2018, Vol. 158(5) 783–800

Approved By

Improving Antimicrobial Prescribing Group

Document history

LHP version 2.0

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