Abstract
BackgroundAdenotonsillectomy results in postoperative morbidity which otolaryngologists attempt to reduce by use of antibiotics. The regimes used as quite varied with some opting for a full oral course postoperatively while others prefer prophylactic doses. This randomised clinical trial done in Kenyatta National Hospital, Kenya had the aim of comparing the efficacy of Co-Amoxiclav given as a single intravenous dose with a full oral course in the prevention of post adenotonsillectomy morbidity.Methods126 patients below 12 years scheduled to undergo adenotonsillectomy were randomised into two groups. 63 were given a single intravenous dose of Enhancin [Co-Amoxiclav] at induction while the remaining half received a five days oral course of the same postoperatively. All received oral Pacimol [Paracetamol] in the postoperative period. Analysis was done and comparison made between the two groups with regards to pain, fever and diet tolerated in the postoperative period with a follow up period of seven days.ResultsThere was no statistical significant difference between the two groups with regards to postoperative pain, fever and diet tolerated. All had a P-value > 0.2. Postoperative pain was highest in the first postoperative day and reduced progressively to the lowest level on the 7th postoperative day. As pain reduced, patients were able to tolerate a more solid diet with all but 6 tolerating their usual diet. 4 patients developed fever in the 1st postoperative day which did not progress to the next day. One patient had fever on the 4th and 7th postoperative day and was admitted in the paediatrics' ward with a chest infection. All these patients with history of fever were in the group that was on oral postoperative Co-Amoxiclav.ConclusionA single intraoperative dose of Co-Amoxiclav given intravenously at induction was found to be just as effective as a full oral course of the same given postoperatively in the prevention of post adenotonsillectomy morbidity. The prophylactic dose is favoured over the later as it is cheaper, ensures compliance and relieves off the need for refrigeration of the oral suspension as not all have access to refrigeration in low economy countries as ours.Trial registrationClinicalTrials.gov: NCT01267942
Highlights
Adenotonsillectomy results in postoperative morbidity which otolaryngologists attempt to reduce by use of antibiotics
Many studies have been done with regards to perioperative antibiotic use with regards to adenotonsillectomy none of which was found to focus on prophylactic single preoperative intravenous antibiotic
The excluded had 5 patients in Group B who were given postoperative Amoxycillin instead of Enhancin [Co-Amoxiclav]. 2 patients in Group A were erroneously prescribed for postoperative oral Enhancin [CoAmoxiclav] after they had already received the single intraoperative intravenous dose of the antibiotic. 8 patients failed to turn up for review, 4 in either group
Summary
Adenotonsillectomy results in postoperative morbidity which otolaryngologists attempt to reduce by use of antibiotics. Adenotonsillectomy is a clean contaminated operation for which prophylaxis is indicated This aims at reducing microbial burden at the operation site as antibiotic is administered intravenously prior to contamination of previously sterile tissues [2,3]. This relieves the need to taking oral postoperative medication the compliance of which may be suboptimal post adenotonsillectomy due to odynophagia that results from traumatised pharyngeal tissues with possibility of resistance development. Many studies have been done with regards to perioperative antibiotic use with regards to adenotonsillectomy none of which was found to focus on prophylactic single preoperative intravenous antibiotic This prompted us to do this study which compares prophylactic doses of Enhancin [Co-amoxiclav] with full postoperative oral courses of the same
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