Page 16 - HPP ANTIMICROBIAL GUIDELINE 2018

Suggested Treatment
Infection/ Condition Comments
Preferred Alternative

OTORHINOLARYNGOLOGY SURGERY

Head and neck Antibiotic not required
Clean, adenotonsillectomy, otoplasty,
lymphadenectomy, septoplasty,
laryngeal microsurgery, tympanoplasty

Clean with placement of prosthesis, tissue Cefuroxime 1.5gm IV Amoxicillin/clavulanate 1.2gm IV May continue antibiotic for
flaps 1-5 days
(excludes tympanostomy tubes) PLUS
Metronidazole 500mg IV

Clean-contaminated cancer surgery Amoxicillin/clavulanate 1.2gm IV Cefuroxime 1.5gm IV Endoscopic sinus surgery with
chronic rhinosinusitis suggest
Other clean-contaminated procedures PLUS Amoxicillin/clavulanate
Metronidazole 500mg IV 7 days preoperative and for total
Endoscopic sinus surgery with chronic 14 days
rhinosinusitis, nasal graft surgery,
cochlear implant, total laryngectomy,
mastoidectomy, resection of nasal tumour,
uvulopalatopharyngoplasty

References:
1. Am J Health-System Pharm. 2013; 70:195-283, 2013@IDSA
2. Michael PV, Susan LD, Amy MW, John EM, Tamer AG. Considerations for Antibiotic Prophylaxis in head and Neck Cancer Surgery. Oral Oncology.
2017.
3. Skitarelić N, Morović M, Manestar D. Antibiotic prophylaxis in clean contaminated head and neck oncological surgery. J Craniomaxillofacial
Surg.2007; 35:15-20.
4. National Institute for Health and Clinical Excellence. Surgical site infection (clinical guideline 74) 2008.
5. www.nice.org.uk/CG74 (accessed 2012 Dec 9)
6. Fennessy BG, Harney M, O’Sullivan MJ et al. Antimicrobial prophylaxis in otorhinolaryngology/head and neck surgery. Clin Otolaryngol.2007; 32:204

HPP AMG Chemoprophylaxis 3