Recommendations
| Дозування | Ремарки | |
|---|---|---|
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Laryngeal endoscopy (diagnostic, therapeutic, laser, (botox) injections) No prophylaxis |
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cefazolin iv 2000mg
+ metronidazole iv 500mg |
Zenker stapler / laser with cricopharyngeus |
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Clean neck procedure (parotid, submandibular gland, branchial cleft cyst, neck dissection) No prophylaxis
(Clean neck procedure where asepsis cannot be maintained perioperatively (for example drapes shifting) perioperatively 2 grams cefazolin) |
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cefazolin iv 2g
+ metronidazole iv 500mg |
Clean-contaminated neck procedure (opening of the airway and/or pharynx such as with external Zenker) |
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cefazolin iv 2g
+ metronidazole iv 500mg |
High-risk operation with risk of fistula (for example free flap, Commando, total laryngectomy) (postoperative 2 days amoxicillin/clavulanic acid 3 times daily 500/125 mg) |
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Tonsillectomy, insertion of Provox No prophylaxis |
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Resection of oral cavity lesion (without continuity to the neck) No prophylaxis |
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cefazolin iv 2g
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Lateral rhinotomy
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Implantology: outpatient, without risk factors * no prophylaxis |
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amoxicillin po 2000mg
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Implantology: outpatient, with risk factors * Postoperatively 3 times daily 500 mg for 5 days (10 days for procedures in irradiated tissue) |
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cefazolin iv 2g metronidazole iv 500mg
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Implantology: inpatient, bone augmentation without sinus floor elevation Postoperatively 5 days amoxicillin/clavulanic acid 3 times daily 625 mg |
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cefazolin iv 2g metronidazole iv 500mg
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Implantology: inpatient, placement of implants Postoperatively amoxicillin 3 times daily 500 mg for 5 days |
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cefazolin iv 30mg/kg metronidazole iv 10mg/kg
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Cleft: BIG (bone in gnathion) |
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cefazolin iv 30mg/kg
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Cleft: Lip |
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cefazolin iv 30mg/kg
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Cleft: FP (Pharynxplasty)
Postoperative extended prophylaxis 4 days amoxicillin/clavulanic acid 3 times daily 625 mg |
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cefazolin iv 2g metronidazole iv 500mg
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Orthognathic surgery (BSSO, Bimax, SARME) |
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cefazolin iv 2g metronidazole iv 500mg
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Fractures, intra-oral approach |
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Fractures, extra-oral approach No prophylaxis unless complicated fracture. Then a single dose cefazolin iv 2g |
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Post-operative haematoma No (post-operative) prophylaxis |
| Дозування | Ремарки | |
|---|---|---|
|
FESS, DCR, septoplasty No prophylaxis |
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cefazolin iv 2g
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External rhinoplasty |
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Clean facial procedure (gold weight, canthopexy, small reconstruction of skin defect, otoplasty) No prophylaxis |
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cefazolin iv 2g
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Clean-contaminated facial procedure (such as external sinus drainage, lateral rhinotomy, large skin defect reconstruction, other major facial procedures)
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cephalexin po 2g
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Large and/or complex dermato-oncological excisions and reconstructions (under local anaesthesia). Administration of cephalexin 2 grams orally, 40-60 minutes before the procedure. |
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Nasal packing ≤ 4 days no prophylaxis |
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amoxicillin + clavulanic acid po 500/125mg 3dd
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Nasal packing >4 days (if duration can be predicted beforehand, otherwise start on day 4)
amoxicillin/clavulanic acid for the remaining days while nasal packing is in place |
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Fractures No prophylaxis unless complicated fracture, then a single dose cefazolin iv 2 grams. |
| Дозування | Ремарки | |
|---|---|---|
|
Stapedotomy opening inner ear/dura
No extended prophylaxis
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cefazolin iv 30mg/kg
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Clearance for chronic otitis media with/without cholesteatoma: - WITH active pre- or peri-operative otorrhoea (no extended prophylaxis, but extend therapeutically based on culture) - WITHOUT active pre- or peri-operative otorrhoea (no extended prophylaxis) - WITH obliteration using autologous material (no extended prophylaxis) - WITH obliteration using foreign material (no extended prophylaxis) - WITH pre- or peri-operative CSF leak or perilymph leak (opening inner ear/dura)
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Tympanostomy tubes No prophylaxis |
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Bone Implant (BI) implant No prophylaxis |
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Middle ear inspection (MOI) +/- ossicular reconstruction (implant) No prophylaxis |
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Meatoplasty No prophylaxis |
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Myringoplasty and tympanoplasty No prophylaxis |
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Correction of membranous and bony atresia No prophylaxis |
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cefazolin iv 30mg/kg
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Auricular reconstructions/otoplasty with rib cartilage
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cefazolin iv 30mg/kg
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Cochlear implant (CI) (uni- and bilateral) implant, opening inner ear/dura |
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Auricular haematoma no prophylaxis |
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Active middle ear implants no prophylaxis |
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Facial nerve decompression no prophylaxis |
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cefazolin iv 30mg/kg
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Subtotal petrosectomy: - for infected CRH no extended prophylaxis, but extend therapeutically based on culture - for cholesteatoma, 1 week extended prophylaxis amoxicillin/clavulanic acid 3 times daily 625 mg
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cefazolin iv 30mg/kg
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Skull base surgery extended prophylaxis 1 week amoxicillin/clavulanic acid 3 times daily 625 mg
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cefazolin iv 30mg/kg
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Closure of CSF leak no extended prophylaxis
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* risk factors
Smoking, prominent jaw (especially maxilla), diabetes mellitus, use of immunosuppressants, use of bisphosphonates, use of autologous, alloplastic or xenogeneic material with simultaneous placement of an implant.
Otology: Prophylaxis at induction 30 mg/kg, maximum 2 grams; for prolonged procedures: repeat after 4 hours with 15 mg/kg, max 1 gram
Cefazolin meets all criteria, therefore first-line agent
Clindamycin for allergy to beta-lactam agents. See protocol: Beleid bij allergie voor antibiotica | Radboud UMC
Amoxicillin/clavulanic acid for contamination with anaerobes
Note: Pseudomonas and Enterobacterales are not covered by cefazolin
For a number of recommendations there is still a knowledge gap regarding treatment; this will be further investigated. These concern:
- clearance for chronic otitis media with/without cholesteatoma WITHOUT active pre- or peri-operative otorrhoea
- closure of CSF leak
- extended prophylaxis in skull base surgery
- extended prophylaxis in subtotal petrosectomy in relation to cholesteatoma