The More the Merrier? Should Antibiotics be Used for Rhinoplasty and Septorhinoplasty?—A Review

Abstract

Background:With antimicrobial resistance a global threat, optimizing antibiotic usage across the surgical continuum is vital. The American Academy of Otolaryngology—Head and Neck Surgery Foundation recently published the first guidelines addressing management in rhinoplasty. The authors reviewed pertinent literature on the role of systemic antibiotics in rhinoplasty and septorhinoplasty.Methods:The authors performed a MEDLINE search through PubMed using the key terms rhinoplasty, septorhinoplasty, infection, antimicrobials, and antibiotics.Results:Ten studies met criteria. Studies evaluating antibiotics perioperatively showed similar infection and/or bacteremia rates (0–13.3%) in those receiving or not receiving antibiotics. No patients experienced significant local/systemic infections regardless of antibiotic use. In the 3 studies evaluating antibiotics postoperatively, antibiotics decreased the infection rate from 27% to 8% in complex revision cases. In a study evaluating postoperative antibiotics in noncomplex cases, there were no significant differences in infection rates between those receiving only a preoperative dose and those receiving preoperative in addition to 7 days of postoperative antibiotics, with the latter experiencing higher rates of antibiotic-related adverse events and costs.Conclusions:Peri- and postoperative antibiotics in noncomplex rhinoplasty and septorhinoplasty are not beneficial in decreasing infection risk. Antibiotics, with a first-generation cephalosporin such as cefazolin (non–β-lactam, such as clindamycin, if β-lactam allergy), should be considered in patients with comorbidities/undergoing complex surgery. If perioperative antibiotics are used, antibiotics should be administered within 1 hour of incision and discontinued within 24 hours of the operation. Further research is warranted to evaluate the optimal duration of postoperative antibiotics in complex cases.

Incidence and Predisposing Factors of Postoperative Infection after Rhinoplasty: A Single Surgeon’s 16-Year Experience with 2630 Cases in an East Asian Population

“…3,5 Compromised vascular supply to the nasal skin from prior operations or trauma is also believed to predispose. 5 It has further been demonstrated that patients with diabetes have an increased incidence of nasal colonization with Staphylococcus aureus, 3 which itself is linked to the development of postoperative infection. 6 Given the seriousness of this complication, we believe it is important to establish postrhinoplasty infection rates and predisposing factors, based on data from larger scale studies.…”

“…3,4 At present, identified risk factors for postrhinoplasty infection include cigarette smoking and length of procedure greater than or equal to 3 hours. 3,5 Compromised vascular supply to the nasal skin from prior operations or trauma is also believed to predispose. 5 It has further been demonstrated that patients with diabetes have an increased incidence of nasal colonization with Staphylococcus aureus, 3 which itself is linked to the development of postoperative infection.…”

Are Antibiotics Needed in Septorhinoplasty? An Evidence-Based Approach

“…For any other facial plastic surgery where implants are used, antibiotics should be considered. Significant medical comorbidities (American Society of Anaesthesiologist Score of 3 or above) have also been proposed as indications for prophylactic antibiotic use, however the evidence is weak and are not currently included in national guidelines 14 .…”

“…Significant medical comorbidities (American Society of Anesthesiologist Score of 3 or above) have also been proposed as indications for prophylactic antibiotic use; however, the evidence is weak and are not currently included in national guidelines. 14 A separate case that is worthy of mention is when SRP surgery is combined with functional endoscopic sinus surgery (FESS). Lee et al compared perioperative and early postoperative complication rates of performing open SRP and FESS.…”

Clinical Practice Patterns and Evidence-Based Medicine in Secondary Cleft Rhinoplasty: A 14-Year Review of Maintenance of Certification Tracer Data From the American Board of Plastic Surgery

“…Although antibiotic use was not discussed in MOC EBM articles, a 2018 review of antibiotic use in rhinoplasty recommended against perioperative or postoperative antibiotic use in primary rhinoplasty (LOE II; Kullar et al, 2018) However, for complex or revision rhinoplasty, which would include secondary cleft rhinoplasty, perioperative antibiotics were recommended within 60 minutes of incision. It was also recommended that postoperative antibiotics be considered in complex cases (complicated revision rhinoplasties, complete rhinoplasties with septal reconstruction, osteotomies, wedge resection, and free transplant), although data were insufficient to recommend a duration (Kullar et al, 2018). The tracer data suggest that antibiotic use, particularly postoperatively, is often given without specific established criteria for doing so.…”