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Antibiotics to improve recovery following tonsillectomy: a systematic review.
Otolaryngol Head Neck Surg. 2006 Mar; 134(3):357-64.OH

Abstract

OBJECTIVE

To determine if antibiotics improve recovery following tonsillectomy.

DATA SOURCES

Electronic databases Medline, Embase, and Cochrane Controlled Trials Register were searched using relevant search terms. Additional trials, if any, were retrieved by searching the references from all identified trials, reviews, correspondences, editorials, and conference proceedings. No language restriction was applied.

STUDY SELECTION

Systematic review of trials in which antibiotic was administered as a study medication intraoperatively and/or postoperatively, in children or adults undergoing tonsillectomy or adenotonsillectomy. Only randomized, placebo-controlled, double-blind trials attaining preset quality scores were included. Outcomes analyzed: 1) pain, need for analgesia, fever, halitosis, and return to normal diet and activities; 2) secondary hemorrhage using 2 parameters-significant hemorrhage (ie, warranting readmission, blood transfusion, or return to theatre for hemostasis) and total hemorrhage; and 3) adverse events.

RESULTS

Five trials met the eligibility criteria. Antibiotics significantly reduced the number of subjects manifesting fever (relative risk [RR]: 0.62, 95% confidence interval [CI]: 0.45, 0.85) and duration of halitosis (-1.94 [-3.57, -0.30] days), and marginally reduced the time taken to resume normal activity (-0.63 [-1.12, -0.14] days), but had no significant effect in reducing pain scores (-0.01 [-0.60, 0.57]) or need for analgesia. Similarly, there was no significant difference in the time taken to resume normal diet or incidence of significant and total hemorrhage, although data was underpowered to detect differences for these outcomes. In the antibiotic group 4 patients developed an adverse reaction (3 cases of rash and 1 case of oropharyngeal candidiasis), while in the control group 1 patient had an adverse reaction (rash). The RR of antibiotic-related adverse events was 2.45 (0.45, 13.31).

CONCLUSION

Antibiotics appear to be effective in reducing some, but not all, morbid outcomes following tonsillectomy, and may increase the risk of adverse events. Further trials are needed to better define the role of antibiotics in facilitating post-tonsillectomy recovery.

EBM RATING

A-1a.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, Raigmore Hospital, 49 Cedarwood Drive, Inverness IV2 6GU, UK. dhiwamahi@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

16500427

Citation

Dhiwakar, Muthuswamy, et al. "Antibiotics to Improve Recovery Following Tonsillectomy: a Systematic Review." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 134, no. 3, 2006, pp. 357-64.
Dhiwakar M, Eng CY, Selvaraj S, et al. Antibiotics to improve recovery following tonsillectomy: a systematic review. Otolaryngol Head Neck Surg. 2006;134(3):357-64.
Dhiwakar, M., Eng, C. Y., Selvaraj, S., & McKerrow, W. S. (2006). Antibiotics to improve recovery following tonsillectomy: a systematic review. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 134(3), 357-64.
Dhiwakar M, et al. Antibiotics to Improve Recovery Following Tonsillectomy: a Systematic Review. Otolaryngol Head Neck Surg. 2006;134(3):357-64. PubMed PMID: 16500427.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antibiotics to improve recovery following tonsillectomy: a systematic review. AU - Dhiwakar,Muthuswamy, AU - Eng,Chee Y, AU - Selvaraj,Sivasubramaniam, AU - McKerrow,William S, PY - 2005/08/02/received PY - 2006/2/28/pubmed PY - 2006/4/12/medline PY - 2006/2/28/entrez SP - 357 EP - 64 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 134 IS - 3 N2 - OBJECTIVE: To determine if antibiotics improve recovery following tonsillectomy. DATA SOURCES: Electronic databases Medline, Embase, and Cochrane Controlled Trials Register were searched using relevant search terms. Additional trials, if any, were retrieved by searching the references from all identified trials, reviews, correspondences, editorials, and conference proceedings. No language restriction was applied. STUDY SELECTION: Systematic review of trials in which antibiotic was administered as a study medication intraoperatively and/or postoperatively, in children or adults undergoing tonsillectomy or adenotonsillectomy. Only randomized, placebo-controlled, double-blind trials attaining preset quality scores were included. Outcomes analyzed: 1) pain, need for analgesia, fever, halitosis, and return to normal diet and activities; 2) secondary hemorrhage using 2 parameters-significant hemorrhage (ie, warranting readmission, blood transfusion, or return to theatre for hemostasis) and total hemorrhage; and 3) adverse events. RESULTS: Five trials met the eligibility criteria. Antibiotics significantly reduced the number of subjects manifesting fever (relative risk [RR]: 0.62, 95% confidence interval [CI]: 0.45, 0.85) and duration of halitosis (-1.94 [-3.57, -0.30] days), and marginally reduced the time taken to resume normal activity (-0.63 [-1.12, -0.14] days), but had no significant effect in reducing pain scores (-0.01 [-0.60, 0.57]) or need for analgesia. Similarly, there was no significant difference in the time taken to resume normal diet or incidence of significant and total hemorrhage, although data was underpowered to detect differences for these outcomes. In the antibiotic group 4 patients developed an adverse reaction (3 cases of rash and 1 case of oropharyngeal candidiasis), while in the control group 1 patient had an adverse reaction (rash). The RR of antibiotic-related adverse events was 2.45 (0.45, 13.31). CONCLUSION: Antibiotics appear to be effective in reducing some, but not all, morbid outcomes following tonsillectomy, and may increase the risk of adverse events. Further trials are needed to better define the role of antibiotics in facilitating post-tonsillectomy recovery. EBM RATING: A-1a. SN - 0194-5998 UR - https://www.unboundmedicine.com/medline/citation/16500427/Antibiotics_to_improve_recovery_following_tonsillectomy:_a_systematic_review_ L2 - https://journals.sagepub.com/doi/10.1016/j.otohns.2005.12.016?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -