An audit of prophylactic antibiotic treatment following tonsillectomy in children

Abstract

A prospective audit study was undertaken to assess the effect of two different management policies following tonsillectomy in children in this hospital, one of which requires a prophylactic five-day course of oral antibiotics and the other does not. A total of 95 children were entered into the trial: 54 received post-operative antibiotics and 41 did not. The post-operative recovery was assessed by completion of a parent questionnaire which included the following parameters: degree of patient distress, nausea and vomiting, otalgia, halitosis, pharyngeal bleeding, analgesic requirement, day of return to a regular diet and General Practitioner consultation. There was no significant reduction in any of the morbidity measures in patients treated with antibiotics. In fact, the analgesic requirement and the incidence of otalgia and irritability on Days 6 and 7 and secondary haemorrhage were significantly higher in the antibiotic-treated patients. Although the number of patients included in this study are small, the results suggest that post-operative antibiotics do not improve the outcome of uncomplicated tonsillectomy. Our previous practice of routinely administering antibiotics to post-tonsillectomy children has been discontinued as the consequence of this audit.

Current practice patterns in tonsillectomy and perioperative care

“…The reason given for antibiotic use were consistent with what is reported in the literature: decreased postoperative pain with improved oral intake, and a reduction in mouth odor [20,21]. However, there have been some studies refuting these benefits and noting the disadvantage of potential bacterial resistance [22].…”

High Incidence of Post-Tonsillectomy Secondary Haemorrhage Following Coblation Tonsillectomy

“…O'Reilly et al [20], Lee et al [21] found no evidence of reduced secondary haemorrhage rate following routine use of prophylactic antibiotics and question the justification of using prophylactic antibiotic routinely. Dhiwakar et al [22] in their meta-analysis of ten studies in the Cochrane review found no significant reduction in post-tonsillectomy bleeding and the routine use of prophylactic antibiotic.…”

The use of perioperative antibiotics in tonsillectomy: Does it decrease morbidity?

“…On further review of the remaining 18 articles, 7 were withdrawn due to a lack of data regarding the primary clinical outcome of interest [9][10][11][12][13][14][15], and 5 were withdrawn due to the absence of a control 856 S. Iyer et al [16][17][18][19][20]. The seven remaining studies with usable information on post-operative outcomes of interest were included in the qualitative portion of this meta-analysis [21][22][23][24][25][26][27]. Of these articles, only four randomized clinical trials met the requirement of both reporting time required for return to normal diet and reporting appropriate measures of significance to allow for a quantitative analysis [21][22][23][24].…”