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[Antibiotic treatment in surgery for cholesteatoma]
E Matiñó1, M P Venegas, S Díez
1Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona.
Abstract:
Cholesteatoma surgery is considered as a dirty one and consequently tributary of preoperative and postoperative antibiotic treatment. Thirty-seven patients diagnosed of cholesteatoma and surgically treated in 1994 are retrospectively analyzed in this article. All of them, whether or not presented with active preoperative otorrhea, received a protocolized antibiotic treatment with topical gentamicin and dexamethasone and oral clindamycin during seven postoperative days. The presence or absence of preoperative or postoperative infection, usually as suppuration is analyzed. Otopyorrhea occurred in 22 patients (62%) before surgery and only in 9 cases (25%) after surgery. Preoperative discharging ears showed greater disposition to continuing the suppuration. The surgical technique followed and the reconstructive middle ear procedure--with autologous bone or other synthetic materials (PORP, TORP)--have not proved, statistically, any predictably value regarding the appearance of any active postoperative infection. As a result of the study done, oral ciprofloxacin has been protocolized only in those adults showing a refractory suppuration to the antibiotic treatment employed. In patients with preoperative otorrhea, topical ciprofloxacin has been protocolized before surgery with the main aim to decrease the postoperative infections incidence of these cases.
Insights
This study on cholesteatoma surgery found that while preoperative infection is common, postoperative infections can be reduced with targeted antibiotic protocols. Specific antibiotics are now used for refractory cases and those with preoperative otorrhea.
Area of Science:
- Otolaryngology
- Infectious Disease
Context:
- Cholesteatoma surgery is often considered a 'dirty' procedure, necessitating antibiotic use.
- A retrospective analysis of 37 cholesteatoma patients treated in 1994 was conducted.
Purpose:
- To analyze the incidence of preoperative and postoperative infections (suppuration) in cholesteatoma surgery.
- To evaluate the effectiveness of a standardized antibiotic protocol.
Summary:
- All patients received topical gentamicin and dexamethasone with oral clindamycin for seven days post-surgery.
- Preoperative otopyorrhea occurred in 62% of patients, decreasing to 25% post-surgery.
- Surgical technique and reconstructive materials did not statistically predict postoperative infection.
- Oral ciprofloxacin was protocolized for refractory suppuration, and topical ciprofloxacin for preoperative otorrhea to reduce infection rates.
Impact:
- The study led to protocolizing oral ciprofloxacin for refractory infections and topical ciprofloxacin for preoperative otorrhea.
- This targeted approach aims to decrease the incidence of postoperative infections in cholesteatoma surgery.