Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2004;2004(3):CD003996.
doi: 10.1002/14651858.CD003996.pub2.

Antibiotic prophylaxis in clean and clean-contaminated ear surgery

H P Verschuur  1 , W W H de Wever, P P G van Benthem
Affiliations

Antibiotic prophylaxis in clean and clean-contaminated ear surgery

H P Verschuur et al. Cochrane Database Syst Rev. 2004.

Abstract

Background: Ear surgery may be performed in the treatment of chronic otitis media, ossicular chain disorders, tympanic membrane perforations and otitis media with effusion. Postoperative infection in ear surgery may result in: Wound infections Infection of the middle ear or mastoid resulting in discharge from the ear canal Failure of the tympanic membrane to close Labyrinthitis due to infection in, or adjacent to, the inner ear These complications may be associated with discomfort and inconvenience for the patient, an increase in morbidity and an increase in the costs of medical care.

Objectives: The objective of this review was to assess the effects of local and/or systemic antibiotics for preventing complications such as postoperative discharge, graft failure and labyrinthitis in patients undergoing clean or clean-contaminated ear surgery.

Search strategy: We searched MEDLINE (searched January 1966 to December 2002), EMBASE (searched January 1980 to December 2002), the Science Citation Index, The Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library, Issue 4 2002); the Cochrane Acute Respiratory Infections Group and Cochrane Ear, Nose and Throat Group Specialised Registers and proceedings of scientific meetings. The date of the last search was December 2002. We also contacted investigators in the field (Govaerts, Antwerp). Bibliographies of identified articles were screened for further relevant trials. No language restriction was applied.

Selection criteria: Randomised or quasi-randomised trials involving:

Participants: patients undergoing clean or clean-contaminated types of ear surgery. Skull base surgery was excluded.

Intervention: any regimen of local and/or systemic antibiotic prophylaxis administered at or around the time of surgery compared to placebo, no antibiotic, or an alternative intervention group.

Outcome measures: infection, discharge, graft failure, labyrinthitis, adverse effects of prophylaxis.

Data collection and analysis: When possible, investigators were contacted for additional information on data and methodological issues. At least two reviewers independently extracted data and assessed trial quality.

Main results: Eleven studies were included in the review. The methodological quality of the trials was fair to good. However, most studies presented insufficient detail on methodological data. Although definitions of outcome measures were heterogeneous, pooling of results was possible. There were no significant differences between antibiotic prophylaxis groups and control groups in terms of reduction of postoperative infections, graft failures, draining outer ear canals and adverse drug effects.

Reviewers' conclusions: There is no strong evidence that the large scale use of prophylactic of antibiotics in clean and clean-contaminated ear surgery is helpful in reducing postoperative complications such as wound infection, discharge from the outer ear canal, labyrinthitis and graft failure.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Antibiotics in clean and clean‐contaminated ear surgery, Outcome 1 Effect of antibiotics on postoperative infection within three weeks after surgery.
1.2
1.2. Analysis
Comparison 1 Antibiotics in clean and clean‐contaminated ear surgery, Outcome 2 Effect of antibiotics on postoperative infection after six weeks.
1.3
1.3. Analysis
Comparison 1 Antibiotics in clean and clean‐contaminated ear surgery, Outcome 3 Effect of antibiotics on postoperative infection within three months after surgery.
1.4
1.4. Analysis
Comparison 1 Antibiotics in clean and clean‐contaminated ear surgery, Outcome 4 Effect of antibiotics on the status of the outer ear canal two months after surgery.
1.5
1.5. Analysis
Comparison 1 Antibiotics in clean and clean‐contaminated ear surgery, Outcome 5 Effect of antibiotics on graft failure rate within three weeks after surgery.
1.6
1.6. Analysis
Comparison 1 Antibiotics in clean and clean‐contaminated ear surgery, Outcome 6 Effect of antibiotics on graft failure rate between six weeks and three months after surgery.
1.7
1.7. Analysis
Comparison 1 Antibiotics in clean and clean‐contaminated ear surgery, Outcome 7 Effect of antibiotics on graft failure within three months after surgery.
1.8
1.8. Analysis
Comparison 1 Antibiotics in clean and clean‐contaminated ear surgery, Outcome 8 Effect of antibiotics on adverse drug effects.
2.1
2.1. Analysis
Comparison 2 Systemic antibiotics versus no antibiotics in clean and clean‐contaminated ear surgery, Outcome 1 Effect of systemic antibiotics on postoperative infection within three weeks after surgery.
2.2
2.2. Analysis
Comparison 2 Systemic antibiotics versus no antibiotics in clean and clean‐contaminated ear surgery, Outcome 2 Effect of systemic antibiotics on postoperative infection after six weeks.
2.3
2.3. Analysis
Comparison 2 Systemic antibiotics versus no antibiotics in clean and clean‐contaminated ear surgery, Outcome 3 Effect of systemic antibiotics on postoperative infection within three months after surgery.
2.4
2.4. Analysis
Comparison 2 Systemic antibiotics versus no antibiotics in clean and clean‐contaminated ear surgery, Outcome 4 Effect of systemic antibiotics on the status of the outer ear canal two months after surgery.
2.5
2.5. Analysis
Comparison 2 Systemic antibiotics versus no antibiotics in clean and clean‐contaminated ear surgery, Outcome 5 Effect of systemic antibiotics on graft failure rate within three weeks after surgery.
2.6
2.6. Analysis
Comparison 2 Systemic antibiotics versus no antibiotics in clean and clean‐contaminated ear surgery, Outcome 6 Effect of systemic antibiotics on graft failure rate between six weeks and three months after surgery.
2.7
2.7. Analysis
Comparison 2 Systemic antibiotics versus no antibiotics in clean and clean‐contaminated ear surgery, Outcome 7 Effect of systemic antibiotics on graft failure within three months after surgery.
3.1
3.1. Analysis
Comparison 3 Systemic and local antibiotics versus local antibiotics in clean and clean‐contaminated ear surgery, Outcome 1 Effect of systemic and local antibiotics on postoperative infection within three weeks after surgery.
3.2
3.2. Analysis
Comparison 3 Systemic and local antibiotics versus local antibiotics in clean and clean‐contaminated ear surgery, Outcome 2 Effect of systemic and local antibiotics on postoperative infection after six weeks.
3.5
3.5. Analysis
Comparison 3 Systemic and local antibiotics versus local antibiotics in clean and clean‐contaminated ear surgery, Outcome 5 Effect of systemic and local antibiotics on graft failure rate within three weeks after surgery.
3.6
3.6. Analysis
Comparison 3 Systemic and local antibiotics versus local antibiotics in clean and clean‐contaminated ear surgery, Outcome 6 Effect of systemic and local antibiotics on graft failure rate between six weeks and three months after surgery.
3.7
3.7. Analysis
Comparison 3 Systemic and local antibiotics versus local antibiotics in clean and clean‐contaminated ear surgery, Outcome 7 Effect of systemic and local antibiotics on graft failure within three months after surgery.
3.8
3.8. Analysis
Comparison 3 Systemic and local antibiotics versus local antibiotics in clean and clean‐contaminated ear surgery, Outcome 8 Effect of systemic and local antibiotics on adverse drug effects.
4.6
4.6. Analysis
Comparison 4 Local antibiotics versus no antibiotics in clean and clean‐contaminated ear surgery, Outcome 6 Effect of local antibiotics on graft failure rate between six weeks and three months after surgery.
4.7
4.7. Analysis
Comparison 4 Local antibiotics versus no antibiotics in clean and clean‐contaminated ear surgery, Outcome 7 Effect of local antibiotics on graft failure within three months after surgery.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD003996

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Bagger‐Sjoback 1987 {published data only}
    1. Bagger‐Sjoback D, Mendel L, Nord CE. The role of prophylactic antibiotics in middle ear surgery. A study on phenoxymethylpenicillin prophylaxis. American Journal of Otology 1987;8(6):519‐23. [MEDLINE: ] - PubMed
Donaldson 1966 {published data only}
    1. Donaldson JA, Snyder IS. Prophylactic chemotherapy in myringoplasty surgery. Laryngoscope 1966;76:1201‐14.
Eschelman 1971 {published data only}
    1. Eschelman LT, Schleuning AJ 2nd, Brummett RE. Prophylactic antibiotics in otolaryngologic surgery: a double‐blind study. Transactions ‐ American Academy of Ophthalmology and Otolaryngology 1971;75(2):387‐94. [MEDLINE: ] - PubMed
Govaerts 1998 {published data only}
    1. Govaerts PJ, Raemaekers J, Verlinden A, Kalai M, Somers T, Offeciers FE. Use of antibiotic prophylaxis in ear surgery. Laryngoscope 1998;108(1 Pt 1):107‐10. [MEDLINE: ] - PubMed
Hester 1998 {published data only}
    1. Hester TO, Jones RO. Prophylactic antibiotics in surgery for chronic ear disease. Laryngoscope 1998;108(9):1334‐7. [MEDLINE: ] - PubMed
Jackson 1988 {published data only}
    1. Jackson CG. Antimicrobial prophylaxis in ear surgery. Laryngoscope 1988;98(10):1116‐23. [MEDLINE: ] - PubMed
John 1988 {published data only}
    1. John DG, Carlin WV, Lesser HJ, Carrick DG, Fielder C. Tympanoplasty surgery and prophylactic antibiotics: surgical results. Clinical Otolaryngology 1998;13(3):205‐7. [MEDLINE: ] - PubMed
Lildholdt 1986 {published data only}
    1. Lildholdt T, Felding JU, Juul A, Kristensen S, Schouenborg P. Efficacy of perioperative ceftazidime in the surgical treatment of chronic otitis media due to Pseudomonas aeruginosa. Preliminary report of a prospective, controlled study. Archives of Oto‐rhino‐laryngology 1986;243(3):167‐9. [MEDLINE: ] - PubMed
Pirodda 1994 {published data only}
    1. Pirodda A, Saggese D, Farneti G. Antibiotic prophylaxis in otological and otoneurological surgery [L'antibioticoprofilassi nella chirurgia otologica e otoneurologica]. Acta Otorhinolaryngologica Italica 1994;14(3):249‐55. [MEDLINE: ] - PubMed
Tong 2002 {published data only}
    1. Tong MC, Yue V, Ku PK, Hasselt CA. Preoperative topical ofloxacin solution for tympanoplasty: a randomized, controlled study. Otology and Neurotology 2002;23(1):18‐20. [MEDLINE: ] - PubMed
Winerman 1981 {published data only}
    1. Winerman I, Segal S, Man A. Effectiveness of prophylactic antibiotic treatment in mastoid surgery. American Journal of Otology 1981;3(1):65‐7. [MEDLINE: ] - PubMed

References to studies excluded from this review

Leonard 1967 {published data only}
    1. Leonard JR. Prophylactic antibiotics in human stapedectomy. Laryngoscope 1967;77:663‐80. - PubMed
Liu 1983 {published data only}
    1. Liu C, Su WY. A therapeutic trial of aminoglycoside antibiotic in surgical treatment of chronic otitis media. Chinese Medical Journal 1983;31:167‐9.

Additional references

Burke 1961
    1. Burke. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery 1961;50:161‐8. - PubMed
Garner 1988
    1. Garner. CDC definitions for nosocomial infections. American Journal of Infections Control 1988;16:128‐40. - PubMed
Handbook 2008
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 5.0.0 [updated February 2008]. The Cochrane Collaboration, 2008. Available from www.cochrane‐handbook.org.
Kaiser 1986
    1. Kaiser AB. Antimicrobial prophylaxis in surgery. New England Journal of Medicine 1986;315:1129‐38. - PubMed
Waddell 1994
    1. Waddell TK, Rotstein ODSO. Antimicrobial prophylaxis in surgery. Committee on Antimicrobial Agents, Canadian Infectious Diseases Society. Canadian Medical Association Journal 1994;151(7):925‐31. - PMC - PubMed

Publication types

MeSH terms