Antimicrobial prophylaxis for contaminated head and neck surgery.

Area of Science:

• Infectious Diseases
• Surgical Oncology
• Pharmacology

Background:

• Antibiotic prophylaxis in head and neck surgery is debated, particularly regarding optimal drug choice and duration.
• Surgical entry into the aerodigestive tract through the skin is considered a contaminated wound, necessitating prophylaxis.

Purpose of the Study:

• To compare the efficacy of cefazolin alone versus a combination of gentamicin and clindamycin for antibiotic prophylaxis in major head and neck oncologic surgery.
• To determine the optimal duration of antibiotic administration for preventing postoperative wound infections.

Main Methods:

• A double-blind, randomized study involving patients undergoing major head and neck oncologic surgery requiring skin incision into the aerodigestive tract.
• Patients were stratified by disease stage, surgical procedure, and prior tracheotomy/radiation, then randomized to four groups: cefazolin (1 or 5 days) or gentamicin/clindamycin (1 or 5 days).
• Intravenous antibiotics were administered preoperatively and postoperatively; wound infections were assessed daily by unbiased observers.

Main Results:

• Overall wound infection rate was 15%.
• Groups receiving 5-day gentamicin and clindamycin (Group IV, 4%) or 1-day gentamicin and clindamycin (Group III, 7%) showed a statistically significant reduction in infections (P < .05) compared to cefazolin groups (Group I, 33%; Group II, 20%).
• Repair with a regional pectoral flap increased infection risk (P < .05), while laryngectomy had a lower risk than oropharyngeal resection (P < .05).

Conclusions:

• A 5-day course of gentamicin and clindamycin is a highly effective prophylactic regimen for major head and neck oncologic surgery.
• The combination of gentamicin and clindamycin, particularly with a 5-day duration, significantly reduces postoperative wound infection rates.
• Surgical technique and procedure type influence infection risk, independent of antibiotic prophylaxis choice in this study.