Page 17 - HPP ANTIMICROBIAL GUIDELINE 2018
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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
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