Are Intravenous Antibiotics Routinely Indicated in the Management of Secondary Post Tonsillectomy Haemorrhage?

Abstract

Objective: To review secondary posttonsillectomy hemorrhage (SPTH) patients in our unit, assess them for evidence of infection and make recommendations about the routine use of intravenous (iv) antibiotics. Methods: Retrospective review of our departmental tonsillectomy database over 3 consecutive years. Inflammatory markers, temperature, and throat swab results were analyzed. Results: 3160 tonsillectomies were performed; 1856 on children. The patient's age range 273 years. One hundred and twenty-three SPTH cases were recorded (3.9% rate), with a slight female preponderance (61%). All received broad-spectrum IV antibiotics. Twenty percent of SPTH presented on the 5th postoperative day (range days 227). Eighty-four-and-a-half percent of patients had no clinical or laboratory evidence of infection. Nineteen (15.5%) patients had elevated C reactive protein, white cell count, and neutrophils. Forty patients had throat swabs performed with no pathogens isolated. Conclusions: Clinical signs of infection are uncommon in SPTH. The decision to use iv antibiotics in SPTH should be on an individual basis, guided by clinical and laboratory findings.