Antibiotic Use in Primary Palatoplasty: A Survey of Practice Patterns, Assessment of Efficacy, and Proposed Guidelines for Use. Plast Reconstr Surg 2016 Feb;137(2):574-582
Date
01/29/2016Pubmed ID
26818293DOI
10.1097/01.prs.0000475784.29575.d6Scopus ID
2-s2.0-84955593427 (requires institutional sign-in at Scopus site) 12 CitationsAbstract
BACKGROUND: The literature provides no guidelines for antibiotic use in palatoplasty. The authors sought to ascertain practice patterns; review a large, single-surgeon experience, and propose guidelines for antibiotic use in primary palatoplasty.
METHODS: A six-question survey was e-mailed to all surgeons of the American Cleft Palate-Craniofacial Association. A retrospective study was also conducted of the senior author's 10-year primary palatoplasty series, and two groups were studied. Group 1 received no antibiotics. Group 2 received preoperative and/or postoperative antibiotics.
RESULTS: Three hundred twelve of 1115 surgeons (28 percent) responded to the survey. Eighty-five percent administered prophylactic antibiotics, including 26 percent who used a single preoperative dose. A further 23 percent gave 24 hours of postoperative therapy; 12 percent used 25 to 72 hours, 16 percent used 4 to 5 days, and 12 percent used 6 to 10 days. Five percent of surgeons administered penicillin, 64 percent administered a first-generation cephalosporin, 13 percent administered ampicillin/sulbactam, and 8 percent gave clindamycin. The authors reviewed 311 patients; 173 receive antibiotics and 138 did not. Delayed healing and fistula rates did not differ between groups: 16.8 percent versus 15.2 percent (p = 0.71) and 2.9 percent versus 1.4 percent (p = 0.47), respectively. A single patient treated without antibiotics developed a postoperative bacteremia. This case did not meet the Centers for Disease Control definition of a surgical site infection, but the patient developed a palatal fistula.
CONCLUSIONS: Antibiotic use in primary palatoplasty varies widely. The authors' data support a clinician's choice to forego antibiotic use; however, given the significance of palatal fistulae and the single case of postoperative streptococcal bacteremia, the study group recommends a single preoperative dose of ampicillin/sulbactam. Current evidence cannot justify the use of protracted antibiotic regimens.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Author List
Rottgers SA, Camison L, Mai R, Shakir S, Grunwaldt L, Nowalk AJ, Natali M, Losee JEAuthor
Sameer Shakir MD Assistant Professor in the Plastic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Antibiotic ProphylaxisChild, Preschool
Cleft Palate
Female
Humans
Male
Practice Guidelines as Topic
Practice Patterns, Physicians'
Retrospective Studies
Surveys and Questionnaires
Treatment Outcome
