Antibiotics to reduce post-tonsillectomy morbidity

Raigmore Hospital, Department of Otolaryngology, Inverness, UK, IV2 3UJ.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2008; 12(2):CD005607. DOI: 10.1002/14651858.CD005607.pub2
Source: PubMed


Tonsillectomy is a commonly performed operation in children and adults. Following the operation nearly all patients experience significant pain, need regular painkillers and are unable to resume normal diet and activities for several hours. Rarer but more dangerous complications, such as bleeding from the operated area, also occur. Antibiotics are commonly prescribed to reduce some or all of these undesirable consequences of tonsillectomy. The present review, however, suggests that antibiotics do not reduce pain, the need for painkillers or bleeding. They do, however, appear to reduce fever. This relatively minor benefit is more likely to be due to weaknesses in the studies themselves than any direct antibiotic effect. The risk of adverse events, such as skin rash and diarrhoea, is also slightly higher in patients who were prescribed antibiotics. Therefore, in the absence of clear-cut and significant benefit, and with the potential for harm, we advocate against prescribing antibiotics routinely for patients undergoing tonsillectomy.

Full-text preview

Available from:
  • Source
    • "Most RCTs acknowledge a positive and statistically significant effect attributable to the administration of prophylactic antibiotics on the appearance of postoperative fever. The authors concluded that antibiotics might reduce fever [19]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Antibiotic prophylaxis is commonly used to decrease the rate of infections in head and neck surgery. The aim of this paper is to present the available evidence regarding the application of antibiotic prophylaxis in surgical procedures of the head and neck region in healthy patients. A systemic literature review based on Medline and Embase databases was performed. All reviews and meta-analyses based on RCTs in English from 2000 to 2013 were included. Eight out of 532 studies fulfilled all requirements. Within those, only seven different operative procedures were analyzed. Evidence exists for the beneficial use of prophylactic antibiotics for tympanostomy, orthognathic surgery, and operative tooth extractions. Unfortunately, little high-level evidence exists regarding the use of prophylactic antibiotics in head and neck surgery. In numerous cases, no clear benefit of antibiotic prophylaxis has been shown, particularly considering their potential adverse side effects. Antibiotics are often given unnecessarily and are administered too late and for too long. Furthermore, little research has been performed on the large number of routine cases in the above-mentioned areas of specialization within the last few years, although questions arising with respect to the treatment of high-risk patients or of specific infections are discussed on a broad base.
    Full-text · Article · Jul 2014 · BioMed Research International
  • Source
    • "In evaluating bleeding at different time points post-operation, only the amount of bleeding in the first 30 minutes in the recovery room (post-operative immediate bleeding) was significantly different between the intervention groups and the control group (greater in the control group). Injection of anesthetic alone does not have an effect on postoperative bleeding (11), but according to most previous studies, injection of epinephrine with an anesthetic decreases bleeding during the operation but a reduction in postoperative bleeding is not mentioned (12). However, in the present study, a reduction in bleeding immediately after surgery (within the first 30 minutes) was observed, which could be explained by the short duration of effect of epinephrine. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Tonsillectomy is one of the most common surgeries in the world and the most common problem is post-tonsillectomy pain and bleeding. The relief of postoperative pain helps increase early food intake and prevent secondary dehydration. One method for relieving pain is peritonsillar injection of epinephrine along with an anesthetic, which has been shown to produce variable results in previous studies. Study Deign: Prospective case-control study. SETTING: A tertiary referral centers with accredited otorhinolaryngology-head & neck surgery and anesthesiology department. Patients under 15 years old, who were tonsillectomy candidates, were assigned into one of three groups: placebo injection, drug injection before tonsillectomy, and drug injection after tonsillectomy. The amount of bleeding, intensity of pain, and time of first post-operative food intake were evaluated during the first 18 hours post operation. The intensity of pain in the first 30 minutes after the operation was lower in the patients who received injections, but the difference was not significant during the first 18 hours. The intensity of pain on swallowing during the first 6 hours was also lower in the intervention groups as compared with the placebo group. The amount of bleeding during the first 30 minutes post operation was lower in the two groups who received injections, but after 30 minutes there was no difference. Injection of epinephrine and bupivacaine pre- or post- tonsillectomy is effective in reducing pain and bleeding. The treatment also decreases swallowing pain in the hours immediately after surgery.
    Full-text · Article · Sep 2013 · Iranian Journal of Otorhinolaryngology
  • [Show abstract] [Hide abstract]
    ABSTRACT: This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Dhiwakar M, Clement WA, Supriya M, McKerrow WS. Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD005607. DOI: 10.1002/14651858.CD005607.pub2. Further information for this Cochrane review is available in this issue of EBCH in the accompanying EBCH Summary and Characteristics and Key Findings Tables. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration
    No preview · Article · Dec 2008 · Evidence-Based Child Health A Cochrane Review Journal
Show more