Perioperative Prophylactic Antibiotics in Endoscopic Sinus Surgery

Abstract

Objective: Determine if the routine use of prolonged systemic perioperative antibiotics decreases the rate of infection and improves outcomes in patients undergoing endoscopic sinus surgery by performing a systematic review of the available literature. Method: Cochrane (2nd Quarter 2010), Ovid MEDLINE (1950-2010), EMBASE (1988-2010), and Scopus databases were searched. Two authors independently reviewed studies for inclusion and extracted data. All clinical trials examining the impact of perioperative administration of systemic antibiotics on outcomes of endoscopic sinus surgery were included. Qualitative analysis was undertaken. Results: Of 482 articles reviewed, 3 trials met eligibility criteria. These were prospective randomized control trials comparing either no or single dose antibiotics to a prolonged systemic course. The largest study enrolled 202 patients, was double-blinded, and was placebo controlled with good allocation concealment and without loss to follow up. The others were of varying quality (smaller numbers; variable blinding, allocation concealment, and follow-up). None of the trials found a significant difference in prevention of infection. They also failed to show improvement in subjective, endoscopic, or CT evaluation with the use of prolonged antibiotic therapy. Conclusion: The present review suggests that the routine use of systemic perioperative prophylactic antibiotics does not reduce the rate of infections or improve the outcomes of endoscopic sinus surgery and, therefore, should not be automatically prescribed.