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The role of prophylactic antibiotics in middle ear surgery. A study on phenoxymethylpenicillin prophylaxis
D Bagger-Sjöbäck1, L Mendel, C E Nord
1Department of Otorhinolaryngology, Karolinska Hospital, Stockholm, Sweden.
Abstract:
A randomized prospective double-blind study was performed testing the value of phenoxymethylpenicillin in conjunction with middle ear surgery. The patients were evaluated for clinical signs of infection and with bacteriologic cultures both pre- and postoperatively. No difference in clinical signs of infection was noted between the pre- and postoperative evaluations. A significantly larger number of patients, however, presented with postoperative positive bacteriologic cultures as compared with the preoperative cultures. This increase was particularly evident in the placebo group. The two microorganisms that were found in increased numbers postoperatively were Staphylococcus epidermidis and Pseudomonas strains. The value of prophylactic antibiotic treatment and phenoxymethylpenicillin treatment in particular is discussed.
Insights
This study found phenoxymethylpenicillin did not prevent middle ear infection signs after surgery. Postoperative bacterial cultures increased, especially in the placebo group, suggesting antibiotics may alter bacterial presence.
Area of Science:
- Otolaryngology
- Infectious Disease
- Pharmacology
Background:
- Middle ear surgery carries a risk of postoperative infection.
- Prophylactic antibiotics are sometimes used to prevent surgical site infections.
- The efficacy of phenoxymethylpenicillin in this context requires evaluation.
Purpose of the Study:
- To assess the clinical value of phenoxymethylpenicillin prophylaxis during middle ear surgery.
- To evaluate the impact of phenoxymethylpenicillin on postoperative infection rates and bacterial cultures.
- To compare outcomes between antibiotic treatment and placebo groups.
Main Methods:
- A randomized, prospective, double-blind study design was employed.
- Patients underwent middle ear surgery with either phenoxymethylpenicillin or placebo.
- Clinical signs of infection and bacteriologic cultures were assessed pre- and postoperatively.
Main Results:
- No significant difference in clinical infection signs was observed between groups.
- A higher incidence of positive postoperative bacteriologic cultures was noted compared to preoperative cultures.
- This increase in positive cultures was more pronounced in the placebo group, with notable rises in Staphylococcus epidermidis and Pseudomonas strains.
Conclusions:
- Phenoxymethylpenicillin did not demonstrate a clear benefit in preventing clinical signs of infection post-middle ear surgery.
- The study highlights a potential increase in postoperative bacterial colonization, particularly in the absence of prophylactic antibiotics.
- Further investigation into the role and impact of prophylactic antibiotics, including phenoxymethylpenicillin, on the intraoperative microbiome is warranted.