Prophylactic steroids and/or antibiotics to reduce post-tonsillectomy morbidity: a double-blind placebo-controlled trial

Abstract

Objectives The aim of this study was to evaluate the role of postoperative oral steroids (prednisolone) and/or antibiotic (amoxicillin and clavulanic acid) to reduce post-tonsillectomy (with or without adenoidectomy) morbidity. Background Tonsillectomy remains one of the most common surgical procedures performed worldwide. Mortality rates for the operation range from one in 10 000 to one in 35 000, with morbidity rates ranging from 1.5 to 14%. Consequently, antibiotics ± oral steroids are frequently prescribed in an effort to minimize complications such as pain, dehydration, secondary infection of the operative site, and haemorrhage. Materials and methods A total of 265 children subjected to tonsillectomy with or without adenoidectomy were randomly allocated into four groups. The patients were blinded to the postoperative medications that they received: group A, two placebo treatments for 5 days (75 patients); group B, postoperative antibiotic and placebo for 5 days (64 patients); group C, postoperative antibiotic and oral steroid for 5 days (61 patients); and group D, postoperative oral steroid and placebo for 5 days (65 patients). The postoperative recovery was assessed by completion of a questionnaire including the following parameters: pain degree, fever, nausea and vomiting, halitosis, pharyngeal bleeding, analgesic requirement, and the day of return to a normal diet. Results There were no significant differences between the four groups in terms of nausea and vomiting ( P ≥ 0.05), but there was a significant difference between the groups favoring group C in the mean pain score ( P = 0.0001), paracetamol consumption ( P P = 0.01), postoperative bleeding ( P = 0.0007), time taken to return to normal diet ( P P = 0.0005), fourth day ( P = 0.0001), fifth day ( P P P = 0.0002). Conclusion Combined prophylactic oral steroids (prednisolone) and antibiotic (amoxicillin and clavulanic acid) for 5 days after tonsillectomy can reduce the postoperative morbidity.