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Updated: Jan 12, 2026
CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
Clostridioides difficile Infection Risk in Children Prescribed Antibiotics for Tonsillectomy
Erin M Gawel1, Gaayathri Varavenkataraman2, Luke Reardon3
1Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Objective:
To evaluate whether antibiotic use in pediatric patients undergoing tonsillectomy is associated with an increased risk of Clostridioides difficile infection (CDI).
Study Design:
Retrospective cohort study.
Setting:
US Network in TriNetX.
Methods:
Patients younger than 18 years who underwent tonsillectomy between 2006 and 2024 were identified using CPT codes 42820, 42821, 42825, or 42826, SNOMED codes 173422009 or 28913000, or ICD-10-PCS code 0CTP. Two cohorts were created based on whether antibiotics were prescribed within 7 days of surgery. Antibiotic use was identified through medication records. Propensity score matching was applied for age, sex, and race. CDI within 90 days was identified using ICD-10 code A04.7.
Results:
Between 2006 and 2024, antibiotics were prescribed to 16.5% (N = 58,845/356,950) of children undergoing tonsillectomy. After matching, each cohort included 58,722 patients (mean age 6.7 ± 4.1 years). The most common antibiotic prescribed was amoxicillin (N = 37,217, 63.4%), followed by cefazolin (N = 10,226, 17.4%). The prevalence of CDI was significantly higher in the antibiotic group (N = 42, 0.07%) compared to the nonantibiotic group (N = 10, 0.02%, P < .0001). Antibiotic exposure was associated with a fourfold increased risk of CDI (risk ratio [RR] = 4.2, 95% CI: 2.1-8.4, P < .001).
Conclusion:
Despite recommendations against routine antibiotic use in tonsillectomy, a substantial proportion of children receive them. This practice is linked to an elevated risk of CDI, emphasizing the importance of antibiotic stewardship in surgical care.
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