ENT Surgery - Guideline for Antimicrobial Prophylaxis

Publication: 01/01/2009  
Last review: 13/05/2019  
Next review: 02/05/2022  
Clinical Guideline
CURRENT 
ID: 1467 
Approved By: Improving Antimicrobial Prescribing Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2019  

 

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

Summary
ENT Surgery

Procedure

Prophylaxis
recommended?

Evidence level

Prophylaxis intended
to reduce

NNT

Antimicrobial dose/route
Administered within 2 hours of incision/procedure

Routine

MRSA risk# or
penicillin allergic

Routine Ear surgery

NO

A

       

Complex Ear Surgery

YES

C

   

Co-Amoxiclav  1.2g IV single dose

Teicoplanin  400mg IV single dose

Routine nose, sinus and endoscopic sinus surgery or nasendoscopy

NO

A

       

Complex septorhinoplasty

YES if implant used

A

Surgical site infection

 

Co-Amoxiclav  1.2g IV single dose

Teicoplanin  400mg IV single dose

Tonsillectomy

NO

A

       

Adenoidectomy

NO

A

       

Grommet insertion

YES when bleeding or purulence

B

Reduction of otorrhoea

13

Topical framycetin sulphate single dose

 

Head and Neck surgery (clean, benign lesion)

NO

A

       

Head and neck surgery (malignant lesions, neck dissection, contaminated)

YES

A

Reduction in wound infection

6

Co-Amoxiclav  1.2g IV at induction and two further doses 8 hours apart

Teicoplanin  400mg IV single dose

Endocarditis risk

NO unless active infection at site of operation

     

Discuss with Microbiology

 
#see Guidance on MRSA risk and prophylaxis

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Background

The aim of antimicrobial prophylaxis in ENT surgery is a reduction in surgical site infection.  Current practise has been reviewed in light of publication of new guidance from the National Institute for Health and Clinical Excellence (NICE) update February 201714 , the Scottish Intercollegiate Guideline Network update in April 201415  , Evidence-Based Use of Perioperative Antibiotics in Otolaryngology 201816 and in the current era of increasing Clostridium difficile infection, meticillin-resistant Staphylococcus aureus (MRSA) infection and increasing concerns about community-acquired MRSA.  Reducing the risk of acquisition of these pathogens by avoiding unnecessary antimicrobial exposure is a pressing concern. 

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.

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Treatment

Special antimicrobial prophylaxis recommendations

Endocarditis prophylaxis
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.

Evidence level.
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. LTHT Consensus [no national guidelines exist, or guidelines from different learned bodies contradict each other, or no evidence exists]

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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

  1. 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.
  2. Annys E, Jorissen M. Short term effects of antibiotics (Zinnat) after endoscopic sinus surgery. Acta Otorhinolaryngol Belg. 2000;54(1):23-8.
  3. 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.
  4. 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.
  5. 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.
  6. Nawasreh O, Al-Wedyan IA. Prophylactic ciprofloxacin drops after tympanostomy tube insertion. Saudi Med J. 2004 Jan;25(1):38-40.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. Velanovich V. A meta-analysis of prophylactic antibiotics in head and neck surgery. Plast Reconstr Surg. 1991 Mar;87(3):429-34; discussion 35.
  13. 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.
  14. Surgical site infections: prevention and treatment Clinical guideline [CG74] Published date: October 2008 Last updated: February 2017
  15. SIGN. Antibiotic Prophylaxis in Surgery. Scottish Intercollegiate Guideline Network Publication Number 104. Edinburgh; 2008 update April 2014.  
  16. 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 1.0

Related information

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