Ear Nose and Throat Surgery Antibiotic Prophlyaxis

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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

Recommendations for ENT surgical antibiotic prophylaxis

Single dose, IV prophylaxis ≤ 60 minutes prior to skin incision/ intervention.

If >1.5L blood loss replace fluid and repeat antibiotic dose: flucloxacillin, metronidazole, clarithromycin, co-amoxiclav. Give half the original teicoplanin dose if ≥ 1.5L blood loss within the first hour of operation.

If surgery >4hrs repeat co-amoxiclav, flucloxacillin; >8hrs repeat, clarithromycin, co-amoxiclav, flucloxacillin, metronidazole. No repeat dosing of teicoplanin if surgery prolonged.

MRSA: decolonise prior to procedure as per NHS GGC infection control guidelines and discuss with microbiology re antibiotic choice.

CPE carriers: For those patients who have been identified as CPE (carbapenemase producing enterobacteriaceae) carriers, contact microbiology.

Weight > 80 Kg
Increase the dose of antibiotic as below:

  > 100 Kg  
Co-amoxiclav add 1g IV amoxicillin to 1.2g IV co-amoxiclav  
  > 80 Kg > 160 Kg
Clindamycin 900 mg 1200 mg
Metronidazole 1000 mg 1500 mg

Table: Procedure, Recommended Antibiotic, Penicillin Allergy

Procedure Recommended antibiotic Penicillin allergy
Head and neck (contaminated /clean-contaminated) Co-amoxiclav 1.2g IV Clarithromycin 500mg IV + Metronidazole 500mg IV
Head and neck surgery (clean,benign) Not recommended N/A
Open reduction and internal fixation of compound mandibular fractures
Intraoral bone grafting
Co-amoxiclav 1.2g IV Clarithromycin 500mg IV+ Metronidazole 500mg IV
Facial plastic surgery with implant Flucloxacillin 1g IV Teicoplanin 400mg IV
Facial surgery (clean) Not recommended N/A

Complex septorhinoplasty (including grafts)

Cleft lip and palate (major)

Co-amoxiclav 1.2g IV Clarithromycin 500mg + Metronidazole 500mg IV
Grommet insertion Stapedectomy Not recommended N/A
Ear surgery (clean/cleancontaminated) 
Routine nose, sinus and endoscopic sinus surgery
Tonsillectomy
Adenoidectomy (by curettage)
Not recommended N/A

Last reviewed: 17 November 2020

Next review: 30 November 2023

Author(s): Ysobel Gourlay

Version: 5

Author Email(s): [email protected]

Approved By: Antimicrobial Utilisation Committee

Document Id: 205