Comment on 'Antibiotics to reduce post-tonsillectomy morbidity'

摘要

Last year's Food and Drug Administration (FDA) safety communication regarding reported codeine-related deaths in children undergoing adenotonsillar surgery has brought the subject of morbidity after tonsillectomy to the forefront of many of our thoughts. We reproduce [pg 154] the, recently updated, Cochrane review, published in December 2012, examining the efficacy of antibiotics in reducing post-tonsillectomy morbidity. This review encompasses 10 trials including a total of 1035 patients. The authors conclude that there is no rationale in giving antibiotics routinely to patients undergoing tonsillectomy. The post-operative complications that cause most concern for doctors and patients are pain and secondary haemorrhage, and it has traditionally been postulated by ENT surgeons that these are caused by infection of the tonsillar bed. There is, however, very little evidence to support this view. So where do we stand with symptom control after tonsillectomy? There is good evidence to support the use of a dose of perioperative steroid such as dexamethasone. The recently published meta-analysis suggesting an increase in return to theatre following their use was skewed by a single study using very high dosage. In general, the evidence supports a single dose of dexamethasone, and this recommendation is supported by the Scottish Intercollegiate Guideline Network and American Academy of Otolaryngology Clinical Practice Guideline.