Prophylactic antibiotic trends in transsphenoidal surgery for pituitary lesions

Pituitary surgery involves operating in the nasal cavity, which is considered a clean-contaminated wound. In the absence of evidence-based guidelines for preventing surgical site infections in trans-sphenoidal surgery, a survey of current opinion on prophylactic antibiotics might help elucidate the current acceptable practices and identify opportunities for prospective clinical trials that could lead to the development of practice guidelines. An on-line, 10-question, multiple-choice survey was distributed by e-mail link to the membership of the International Society of Pituitary Surgeons. Sixty-nine members responded to the survey. Ninety-one percent indicated that there was no strong evidence supporting antibiotic use, but 81% used them to be safe. Ninety percent of respondents used intravenous prophylactic antibiotics, while only 16% used intranasal antibiotics. The most commonly used antibiotics were cephalosporins (72%) and penicillins (21%). Seventy-six percent used antibiotics for 24 h or less after surgery. The most commonly reported indications for prophylactic antibiotics were prevention of meningitis and sinusitis. The results of the survey describe current acceptable practices for chemoprophylaxis in patients undergoing transsphenoidal pituitary surgery.