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An audit of prophylactic antibiotic treatment following tonsillectomy in children
W C Lee1, M C Duignan, R M Walsh
1Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Insights
This study found that routine post-tonsillectomy antibiotics in children do not improve recovery and may increase complications like pain and bleeding. The hospital has stopped this practice based on the audit results.
Area of Science:
- Pediatric Otolaryngology
- Infectious Disease Management
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Post-operative management often includes antibiotic administration, but its efficacy is debated.
Purpose of the Study:
- To evaluate the impact of prophylactic antibiotics on pediatric tonsillectomy recovery.
- To compare outcomes between children receiving and not receiving post-operative antibiotics.
Main Methods:
- Prospective audit of 95 children undergoing tonsillectomy.
- Comparison of recovery parameters (distress, pain, diet, bleeding) between antibiotic and non-antibiotic groups.
- Parental questionnaire used for outcome assessment.
Main Results:
- No significant reduction in morbidity observed with antibiotic use.
- Increased analgesic requirements, otalgia, irritability, and secondary hemorrhage in the antibiotic group.
- Study suggests antibiotics do not improve outcomes for uncomplicated tonsillectomy.
Conclusions:
- Routine post-operative antibiotics are not beneficial for uncomplicated pediatric tonsillectomy.
- Findings led to discontinuation of previous antibiotic administration policy.
- Further research with larger cohorts may be warranted.
Abstract:
A prospective audit study was undertaken to assess the effect of two different management policies following tonsillectomy in children in this hospital, one of which requires a prophylactic five-day course of oral antibiotics and the other doses not. A total of 95 children were entered into the trial: 54 received post-operative antibiotics and 41 did not. The post-operative recovery was assessed by completion of a parent questionnaire which included the following parameters: degree of patient distress, nausea and vomiting, otalgia, halitosis, pharyngeal bleeding, analgesic requirement, day of return to a regular diet and General Practitioner consultation. There was no significant reduction in any of the morbidity measures in patients treated with antibiotics. I fact, the analgesic requirement and the incidence of otalgia and irritability on Days 6 and 7 and secondary haemorrhage were significantly higher in the antibiotic-treated patients. Although the number of patients included in this study are small, the result suggest that post-operative antibiotics do not improve the outcome of uncomplicated tonsillectomy. Our previous practice of routinely administering antibiotics to post-tonsillectomy children has been discontinued as the consequence of this audit.