Antibiotic Prophylaxis in Clean‐Contaminated Head and Neck Surgery: A Systematic Review and Meta‐analysis

Abstract

Objective To determine the optimal duration and type of antibiotic prophylaxis in patients undergoing clean-contaminated resection for head and neck cancer. Data Sources Search strategies were created by a medical librarian, implemented in multiple databases, and completed in June 2016. Review Methods The population of interest was adults ≥18 years undergoing clean-contaminated head and neck surgery, intervention was postoperative antibiotic prophylaxis, comparator was duration and types of antibiotics used, outcome was the wound infection rate, and the study design was randomized controlled trials (RCTs). Studies were excluded if not randomized, did not use systemic antibiotics, did not study wound infections, or included children. After excluding duplicates, the search strategy yielded 427 abstracts. After applying inclusion and exclusion criteria, 67 studies were screened, leaving 19 RCTs for review. PRISMA guidelines were followed. A random-effects model was used for meta-analysis. Results Meta-analysis of 340 patients in 4 RCTs showed that the pooled relative risk of wound infection was 0.98 (95% confidence interval [CI], 0.58-1.61; P = .718; I = 0.0%) in patients receiving 1 day vs 5 days of prophylaxis. Conclusion This study provides evidence that there is no difference in the risk of wound infection with 1 day vs 5 days of systemic antibiotic prophylaxis in clean-contaminated head and neck surgery, consistent with existing guidelines. Future large randomized trials are needed to more clearly define the appropriate choice of prophylaxis in penicillin-allergic patients.

Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis

“…Multiple studies evaluated the difference in SSI rate between short-and long-term prophylaxis. No statistically significant reduction in the SSI rate could be found in patients receiving prophylaxis for more than 5 days, compared with 1 day postoperatively [6,7,22,24,38,49]. Similarly, one RCT [4] could not demonstrate a beneficial effect in patients receiving prophylaxis for 3 days, compared with 1 day.…”

“…Similarly, a large cross-sectional study showed that a postoperative antibiotic course for longer than 6 days did not further reduce the rate of SSIs (p = 0.08) [23]. Finally, a systematic review found no significant difference between 1 day and or 5 days of prophylaxis using various types of antibiotics including penicillins, cephalosporins, and clindamycin (p = 0.718, RR = 0.98, 95% CI 0.59-1.61) [49]. Sepehr et al [22], comparing cefazolin-metronidazole for less or more than 5 days, showed the same SSI rate in both groups (p = 0.06).…”

Antibiotic prescribing practices in otolaryngology head and neck surgery in Australia and New Zealand: a survey of 137 specialists

“…Current Australian guidelines do not recommend antibiotic prophylaxis in uncomplicated neck dissections (8). While some studies do not support use of prophylactic antibiotics in uncomplicated neck dissection (16), there is level 1a evidence (17) supporting the use of prophylactic antibiotics for 24 hours (18). For thyroidectomy/hemithyroidectomy, 48.93% of the surgeons did not prescribe any antibiotics.…”

What is the optimal duration of antibiotic prophylaxis in clean‐contaminated head and neck surgery?

“…In addition to the above work, a meta‐analysis of 340 patients in 4 RCTs by Vila et al further restricted the antibiotic administration window, comparing the risk of wound infection between 1 day vs 5 days of systemic antibiotic prophylaxis in clean‐contaminated head and neck surgery . All studies included clean‐contaminated oncologic resection of the primary tumor, and roughly a third of these cases included flap reconstruction as part of the surgery.…”

“…In addition to the above work, a meta-analysis of 340 patients in 4 RCTs by Vila et al further restricted the antibiotic administration window, comparing the risk of wound infection between 1 day vs 5 days of systemic antibiotic prophylaxis in clean-contaminated head and neck surgery. 4 All studies included clean-contaminated oncologic resection of the primary tumor, and roughly a third of these cases included flap reconstruction as part of the surgery. Results showed that the overall pooled relative risk (RR) of wound infection was 0.98 (95% confidence interval [CI] 0.58-1.61; P = 0.718) in patients randomized to 1 day of postoperative prophylaxis compared to 5 days of prophylaxis.…”