Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis
Vander Poorten, Vincent; Uyttebroek, Saartje; Robbins, K Thomas; Rodrigo, Juan P; de Bree, Remco; Laenen, Annouschka; F Saba, Nabil; Suarez, Carlos; Mäkitie, Antti; Rinaldo, Alessandra; Ferlito, Alfio
(2020) Advances in Therapy, volume 37, issue 4, pp. 1360 - 1380
(Article)
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
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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.
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Keywords: Evidence based, Guidelines, Head and neck oncology, Head and neck surgery, Meta-analysis, Perioperative antibiotics, Prophylaxis, Systematic review, Anti-Bacterial Agents/administration & dosage, Humans, Clinical Trials as Topic, Surgical Wound Infection/prevention & control, Time Factors, Ampicillin, Adolescent, Adult, Antibiotic Prophylaxis/methods, Head and Neck Neoplasms/surgery, Sulbactam, Pharmacology (medical), Review, Journal Article, Meta-Analysis
ISSN: 0741-238X
Publisher: Springer
Note: Funding Information: No funding or sponsorship was received for this study or publication of this manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Dr. Vincent Vander Poorten conceptualized and designed the systematic review, coordinated and wrote the manuscript. He also critically reviewed and approved the final version of the manuscript. Dr. Saartje Uyttebroek reviewed the literature, collected data based on the PRISMA guidelines and also wrote the manuscript. Annouschka Laenen was responsible for the statistical analysis of the meta-analysis and critically reviewed and approved the final version of the manuscript. K. Thomas Robbins, Juan P. Rodrigo, Remco de Bree, Nabil Saba, Carlos Suarez, Antti Mäkitie, Alessandra Rinaldo and Alfio Ferlito critically reviewed, added elements for discussion and reformulation of text, and approved the final version of the manuscript. Vincent Vander Poorten, Saartje Uyttebroek, K. Thomas Robbins, Juan P. Rodrigo, Remco de Bree, Annouschka Laenen, Nabil Saba, Carlos Suarez, Antti A. Mäkitie, Alessandra Rinaldo and Alfio Ferlito declare that they have no conflict of interest. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. Ethical exemption was provided by the Education-Support Committee (OBC) or the Research Ethics Committee of KU Leuven. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Publisher Copyright: © 2020, The Author(s).
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