Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis

• Type of Material: Article
• Authors: Vincent Vander Poorten, Katholieke University Leuven; Saartje Uyttebroek, Katholieke University Leuven; K. Thomas Robbins, Southern Illinois University; Juan P. Rodrigo, University of Oviedo; Remco de Bree, University Medical Center Utrecht; Annouschka Laenen, Katholieke University Leuven; Nabil Saba, Emory University; Carlos Suarez, University of Oviedo; Antti Maekitie, University of Helsinki; Alessandra Rinaldo, University of Udine; Alfio Ferlito, International Head and Neck Scientific Group
• Language: English
• Date: 2020-04-01
• Publisher: SPRINGER
• Publication Version: Final Published Version
• Copyright Statement: © 2020, The Author(s).
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s12325-020-01269-2
• Title of Journal or Parent Work: ADVANCES IN THERAPY
• Volume: 37
• Issue: 4
• Start Page: 1360
• End Page: 1380
• Grant/Funding Information: No funding or sponsorship was received for this study or publication of this manuscript.
• Keywords: ANTIMICROBIAL PROPHYLAXIS; SHORT-TERM; ONCOLOGIC SURGERY; Research & Experimental Medicine; Meta-analysis; Systematic review; CEFAZOLIN; Prophylaxis; Medicine, Research & Experimental; Evidence based; MAJOR HEAD; COMPLICATIONS; SURGICAL SITE INFECTION; CLINDAMYCIN PROPHYLAXIS; Pharmacology & Pharmacy; Head and neck oncology; METRONIDAZOLE; Science & Technology; Guidelines; Perioperative antibiotics; Life Sciences & Biomedicine; Head and neck surgery; FREE-FLAP RECONSTRUCTION
• Research Categories: Health Sciences, Pharmacology; Health Sciences, Medicine and Surgery

Abstract

Background: The optimal evidence-based prophylactic antibiotic regimen for surgical site infections following major head and neck surgery remains a matter of debate. Methods: Medline, Cochrane, and Embase were searched for the current best evidence. Retrieved manuscripts were screened according to the PRISMA guidelines. Included studies dealt with patients over 18 years of age that underwent clean-contaminated head and neck surgery (P) and compared the effect of an intervention, perioperative administration of different antibiotic regimens for a variable duration (I), with control groups receiving placebo, another antibiotic regimen, or the same antibiotic for a different postoperative duration (C), on surgical site infection rate as primary outcome (O) (PICO model). A systematic review was performed, and a selected group of trials investigating a similar research question was subjected to a random-effects model meta-analysis. Results: Thirty-nine studies were included in the systematic review. Compared with placebo, cefazolin, ampicillin–sulbactam, and amoxicillin–clavulanate were the most efficient agents. Benzylpenicillin and clindamycin were clearly less effective. Fifteen studies compared short- to long-term prophylaxis; treatment for more than 48 h did not further reduce wound infections. Meta-analysis of five clinical trials including 4336 patients, where clindamycin was compared with ampicillin–sulbactam, implied an increased infection rate for clindamycin-treated patients (OR = 2.73, 95% CI 1.50–4.97, p = 0.001). Conclusion: In clean-contaminated head and neck surgery, cefazolin, amoxicillin–clavulanate, and ampicillin–sulbactam for 24–48 h after surgery were associated with the highest prevention rate of surgical site infection.