The first study regarding prophylactic use of antibiotics in surgical procedures was conducted in 19382
; since then, several management regimes have been proposed. The use of prophylactic and postoperative antibiotics is preferred among ENT surgeons to prevent postoperative infections, avoid TSS and legal-medical aspects.1
The most common reasons for antibiotic use according to a survey among the members of the U.S. Society of Rhinology are “to prevent postoperative infection (60.4%), avoid TSS (31.5%) and legal-medical aspects” (4.9%).3
Serious complications such as TSS, endocarditis, sepsis, and meningitis can be observed after septoplasty surgery.5–7
TSS is extremely rare, with an estimated incidence of 0.0002%,1
and there is no evidence that it could be prevented with prophylactic use of antibiotics.3
Therefore, the upper airway and the surgical area of contamination thought to be gaining importance for the postoperative antibiotic therapy,9
but bacteremia after surgery often is not seen.10
If nasal packing was used for 48 hours postoperatively, the risk of bacteremia is increased. Kaygusuz et al.4
found bacteremia in 9 of 53 patients (16.9%) after packing removal. Even if bacteremia was seen, it did not cause serious complications.4
In our study, because of anterior nasal packing, we preferred to use postoperative antibiotics even though bacteremia risk is low. In one study performed in 50 patients who underwent septoplasty, 46% of the patients had nasal mucosa colonized with Staphylococcus aureus
and none of the blood swabs collected during the surgical procedures showed bacterial growth.10
In our study, cephazolin was selected because of its activity against methicillin-susceptible S. aureus and most of the Enterobacteriaceae was isolated from nasal mucosa. Additional considerations were the low cost and good soft tissue and bone penetration of this antibiotic.
Weimert et al.2
evaluated the postoperative interval of 174 patients that had undergone nasal surgeries, which were split into two groups. One group was treated with ampicillin, 500 mg, 12 hours before surgery for 5 days after the procedure, and the other group did not take any antibiotics. Patients were evaluated through questionnaires and serial x ray of paranasal sinuses and there were no significant abnormalities between the groups concerning infection, scabs, bleeding, synechia, pain, or ecchymoses. In our study we evaluated nasal fossa endoscopically even though Weimert did not.
Caniello et al.
a group of patients into three groups—treated with amoxicillin, cefazolin, and not given any antibiotics—and concluded that there was no need to use prophylactic antibiotics. In our study amoxicillin–clavulanate and cefazolin were given to two different groups and there was no statistical significance difference among groups caused by complications postoperatively. We suggest using cephazolin instead of oral antibiotics because cephazolin, 1.0 g i.v., is sufficient to prevent postoperative complications.
Caniello et al.9
stated that there was no statistically significant difference among amoxicillin, cephazolin, and no antibiotics groups concerning the amount of purulent discharge in the nasal fossa. In our study, nasal endoscopy results were similar. There were no differences related to the amount of purulent discharge found at the lower margin of the inferior turbinate through nasal endoscopy performed on the 14th day postoperatively. Three patients in group A and three patients in group B had grade 3 in nasal endoscopy on 7th day. None of the patients received grade 3 or 4 in nasal endoscopy on the 14th day postoperatively.
showed that use of prophylactic antibiotics in elective nasal surgery was not essential because of its low risk of postoperative infection. We believed that although there was a low risk of complications, those complications are fatal3
and antibiotics should be given postoperatively.