When Should Prophylactic Antibiotics Be Given in Head and Neck Surgery?

Prophylactic or preventative antibiotics are administered before some head and neck procedures to stave off potential post-surgical infection.

Prophylactic antibiotics are antibiotics given before surgery to prevent infections.

In head and neck surgery, there is a high incidence of wound infection following operations that involve incisions through the oral or pharyngeal mucosa.

The administration of antibiotics prior to these procedures can decrease postoperative illness and death, shorten hospitalization, and reduce overall costs caused by infections. 

Prophylaxis with antibiotics is indicated only in some types of surgeries but not in others. 

Noncontaminated head and neck surgery refers to operations where incisions are made only on cleaned and prepared skin only and there is no mucosal exposure or incision. These surgeries may not require prophylactic antibiotics. Examples of these surgeries include:

• Neck dissection
• Parotidectomy
• Thyroidectomy

Contaminated head and neck surgery refers to operations that involve incisions through the oral or pharyngeal mucosa. These types of surgeries usually require prophylactic antibiotics to be given. Examples of these surgeries include:

• Composite resection
• Glossectomy
• Maxillectomy
• Nasal and sinus surgery
• Facial fractures, particularly open fractures

High-risk patients may also receive antibiotic prophylaxis. Risk factors include:

• Advanced stage cancers
• Smoking
• Comorbidities
• Major reconstruction of the surgical wound
• Tracheotomy procedure
• Malnourished patients
• Diabetes (possible risk, needs more study)