Is Antibiotic Therapy Warranted in Clean-Contaminated Head and Neck Surgery Beyond 24 h?

Abstract

Antibiotic prophylaxis in head and neck surgery aims to prevent post-operative surgical site infections. While various studies have looked at the effectiveness of perioperative antibiotics delivered in clean-contaminated head and procedures, there remains a lack of consensus on the most effective choice and duration of delivery of antibiotics in preventing post-operative infections. This chapter explores and evaluates the literature regarding antibiotic prophylaxis in clean-contaminated head and neck surgery cases including those in which microvascular free-flap reconstruction was used. Each study was reviewed for its quality of evidence in determining the necessity of antibiotic therapy beyond 24 h in clean-contaminated head and neck surgery. The majority of studies were randomized controlled trials with additional retrospective reviews. Overall, short duration of antibiotics ( 24 h) and avoid unnecessary antibiotic exposure in patients undergoing clean-contaminated head and neck surgery with or without free-flap reconstruction. Additionally, post-operative prophylaxis with clindamycin should be avoided because of its association with increased rates of surgical site infection and antibiotic-induced complications.