Antibiotic prophylaxis in septorhinoplasty? A prospective, randomized study.

Background: The routine use of antibiotics in septorhinoplasty is widespread and recommended in many textbooks despite the lack of scientific evidence for their use. This practice has led to extensive discussions in the face of the emerging threat of antibiotic resistance and rising health care costs. The aim of our study was to investigate the role of antibiotic prophylaxis in septorhinoplasty.

Methods: The authors conducted a prospective, randomized, single-blind study at a tertiary referral center in a private practice setting, including 200 patients undergoing septorhinoplasty over a 4-year period. One hundred patients received preoperative single-shot antibiotics, and the other 100 received a combined regimen with preoperative single-shot antibiotics plus a postoperative 7-day course of oral antibiotics.

Results: Three patients (3 percent) developed postoperative local wound infections in the group with combined treatment; no infections occurred in the group treated with the preoperative single intravenous dose at induction alone, and the difference was not statistically significant. The rate of common antibiotic-induced side effects (e.g., nausea, diarrhea, skin rashes, pruritus) was significantly higher in the combined treatment group (29 percent versus 2 percent, p = 0.03). The cost for antibiotics and medication to treat the side effects per patient was significantly higher in the combined treatment group (93.45 AUD versus 14.50 AUD, p= 0.04).

Conclusion: The authors' results would suggest that a single dose of antibiotics administered preoperatively in endonasal septorhinoplasty with autologous cartilage grafting is sufficient for prophylaxis of postoperative infections, thus eliminating the costs for postoperative antibiotics and the management of their side effects.