Antibiotics in septoplasty: evidence or habit?

Antibiotic prophylaxis for surgical procedures is a common practice among otorhinolaryngologists. Most American Rhinology Society members use antibiotics routinely in septoplasties, even though the need for this practice in rhinological surgery is controversial. This study was designed to assess the necessity of antibiotic prophylaxis in septoplasties in relation to surgical outcome and postoperative complications.

In a prospective randomized clinical trial we evaluated 630 subjects who underwent septoplasty according to the technique already described by the authors. Patients were divided into three groups: group A, no antibiotic prophylaxis; group B, antibiotics (cefazolin at 1.0 g i.v.) only at anesthetic induction; group C, antibiotics both at anesthetic induction (cefazolin at 1.0 g i.v.) and postoperatively (oral amoxicillin at 1 g every 12 hours) for 7 days. Pre- and postoperative patients' scores on the Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire were compared to assess the improvement of nasal symptoms after surgery. Postoperative pain, nasal bleeding, septal hematoma/abscess, fever, and nausea/vomiting were recorded. Nasal endoscopy was performed 14 days postoperatively to quantify purulent rhinorrhea.

An improvement of postoperative nasal symptoms on the NOSE questionnaire was recorded with respect to preoperative score. No significant difference was found among the groups with regard to postoperative pain, fever, nausea/vomiting, and nasal bleeding. No case of hematoma or septal abscess was noticed. No significant difference in purulent nasal discharge was found among the groups.

Septal surgery with early removal of nasal packing is a clean-contaminated procedure and does not require routine antibiotic prophylaxis because of the low infection risk.