The use of prophylactic antibiotics in head and neck oncological surgery

Abstract

Prophylactic antibiotics usage in clean-contaminated major oncological head and neck surgery is mandatory to reduce the risk of infection. In clean major oncological head and neck surgery their use is also advisable but there is no evidence that in clean surgery for benign disease it offers any advantage. Short antibiotic regimes of four doses per 24 h are as effective as prolonged courses regardless of the complexity of the procedure. A combination of antibiotic agents covering aerobic, anaerobic and Gram-negative bacteria is superior to single agents. High-risk patients should be also given short regimes, as there is no evidence that prolonged courses are of more benefit in these patients. Methicillin-resistant Staphylococcus aureus infection can have devastating consequences for patients undergoing major head and neck surgery. Protocols of prevention and treatment should be in place in all institutions treating patients with head and neck cancer. Close collaboration between surgical, microbiology and infection-control teams is essential.

Current Recommendations on Surgical Antimicrobial Prophylaxis

“…Tiroidektomi ve lenf gangliyonu diseksiyonu gibi temiz operasyonlarda CAİ oranı profilaksi verilmediğinde bile %1'in altındadır. Paratiroidektomi, submandibüler gland eksizyonu, tonsillektomi, adenoidektomi, rinoplasti ve mandibula fraktürü onarımı gibi oral faringeal mukoza insizyonu yapılan temiz-kontamine işlemlerde profilaksi uygulanmalıdır (39,40).…”

“…CAİ için risk faktörleri yaş, beslenme durumu, diabetes mellitus, anemi, periferik vasküler hastalık, preoperatif radyasyon ve/veya kemoterapi, sigara ve alkol kullanımıdır (40)(41)(42). Radikal ya da bilateral boyun diseksiyonu ve myokutanöz flep ya da mikrovasküler serbest fleplerle rekonstrüksiyon operasyonları CAİ açısından riskli prosedürlerdir (40,42).…”

“…Radikal ya da bilateral boyun diseksiyonu ve myokutanöz flep ya da mikrovasküler serbest fleplerle rekonstrüksiyon operasyonları CAİ açısından riskli prosedürlerdir (40,42).…”

Salvage surgery for head and neck squamous cell carcinoma

“…the incidence of wound infection has been reported to be as high as 87 %. Short regimen antibiotic prophylaxis covering aerobic and anaerobic bacteria has been shown to reduce the risk of infection in clean-contaminated major oncological head and neck surgery, and is also advisable in clean major oncological head and neck surgery [24]. Smoking and alcohol consumption should be discouraged to reduce the respiratory and metabolic problems associated with these agents.…”

Hospital hygienic surveillance studies and their application

“…The antibiotic has to reach the appropriate concentration during the operation at the site of the expectable contamination. In view of this, the single shot method seems to be insufficient for preventing HCAI in case of microsurgical operations of long duration [63][64][65][66][67][68][69][70][71].…”