Short-term versus long-term antimicrobial prophylaxis in oncologic head and neck surgery

Although antimicrobial prophylaxis is mandatory in major clean-contaminated oncologic surgery of the head and neck, both the choice of specific antimicrobial compounds and the treatment duration are still discussed.

A prospective, randomized trial was carried out to compare efficacy and tolerability of clindamycin-cefonicid administered for 1 day versus 3 days in reducing the rate of wound and systemic infections. The following potential risk factors for surgical wound infection were evaluated: type of surgery, stage of disease, preoperative tracheostomy, preoperative radiotherapy, and diabetes mellitus.

One-hundred sixty-two patients were evaluable; 81 received 1-day chemoprophylaxis, while the remaining 81 were treated according to the 3-day schedule. During the first 20 days after surgery, wound infections occurred in 2 (2.5%) and 3(3.7%) patients, respectively, in the 1-day and 3-day treatment groups, so that no significant difference was found among the two evaluated chemoprophylaxis schedules.

A 3-day schedule did not prove useful in preventing wound and systemic infections. All presumed risk factors were not associated with an increased rate of wound infections, although preoperative radiotherapy was associated with a greater severity of infections and a higher risk of late wound complications.