Are Antibiotics Needed in Septorhinoplasty? An Evidence-Based Approach

Abstract

The use of prophylactic antibiotics in the context of septorhinoplasty (SRP) is a frequently debated topic among plastic surgeons. Most surgeons routinely use antibiotics to prevent the dreaded physical and psychological morbidity of post-operative infections, although this practice is controversial. With antimicrobial resistance becoming a global threat, however, optimising antibiotic prescribing is essential. The current evidence would suggest that the rate of post-operative infection is low and routine antibiotic use is unnecessary in SRP surgery. Rates range from 0.5% to 2% in simple SRP surgery, majority of which are minor nasal infections which respond to oral antibiotics and do not require hospital admission. In cases of complex SRP, defined as revision cases or where grafts or implants have been utilised, infection rates can be much higher with an incidence of 7-11%, and as such utilisation of antibiotics is reasonable. When considering the regime to be utilised, a single preoperative dose of intravenous antibiotics has the same efficacy in reducing the incident of post-operative infection as a postoperative 7-day course of oral antibiotics. In the authors practice, all patients receive a single intravenous dose of antibiotics on induction, and in the case of utilisation of a graft from a non-nasal site, this is complimented with an oral course of post-operative antibiotics. With this approach, infections rates are at the lowest range of available published literature.