EFFICACY OF PROPHYLACTIC ANTIBIOTICS IN REDUCING POST-TONSILLECTOMY HAEMORRHAGE
AbstractBackground: This study aims toward establishing the impact of prophylactic pre-operative antimicrobial therapy on tonsillectomy related haemorrhage. Methods: In this randomized controlled trial conducted at Combined Military Hospital, Abbottabad from January 2017 till August 2019, 121 children and adult patients who had consented and had undergone tonsillectomy were evaluated for procedure related haemorrhage. Results: Incidence rate of secondary post-tonsillectomy haemorrhage and need for re-hospitalization was significantly less in patients who had completed pre-operative prophylactic antibiotics. Patient-reported secondary haemorrhage was recorded in 4.59% (n=9) cases who did not receive pre-operative antibiotic prophylaxis, thereby increasing morbidity and prolonging hospital stay. Secondary post-operative bleeding only occurred in 1.18% (n=2) patients who received appropriate pre-operative anti-microbial prophylaxis. Conclusion: We strongly imply that prophylactic pre-operative antibiotics reduce procedure related complications in all patients undergoing tonsillectomy.Keywords: Tonsillectomy, morbidity, haemorrhage, anti-bacterial agents
Abdelhamid AO, Sobhy TS, El-Mehairy HM, Hamid O. Role of antibiotics in post-tonsillectomy morbidities; A systematic review. Int J Pediatr Otorhinolaryngol 2019;118:192–200.
Verma R, Verma RR, Verma RR. Tonsillectomy-Comparative Study of Various Techniques and Changing Trend. Indian J Otolaryngol Head Neck Surg 2017;69(4):549–58.
Šumilo D, Nichols L, Ryan R, Marshall T. Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records. Br J Gen Pract 2019;69(678):e33–41.
Johnson RF, Chang A, Mitchell RB. Nationwide readmissions after tonsillectomy among pediatric patients-United States. Int J Pediatr Otorhinolaryngol 2018;107:10–3.
Kshirsagar R, Mahboubi H, Moriyama D, Ajose-Popoola O, Pham NS, Ahuja GS. Increased immediate postoperative haemorrhage in older and obese children after outpatient tonsillectomy. Int J Pediatr Otorhinolaryngol 2016;84:119–23.
Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg 2019;160(1_Suppl):S1–42.
Anwar K, Ahmad R, Khan M. Control of bleeding by silk ligation and diathermy coagulation during tonsillectomy: A comparison of efficacy of the two techniques in the first 24 hours after surgery. Pak J Med Sci 2015;31(4):961–4.
Junaid M, Shah G, Khawar A, Roohullah M, Khan MA. Comparison of Peritonsillar Injection of Lignocaine-Adrenaline and Normal Saline (placebo) Before Tonsillectomy in Terms of Mean PerOperative Blood Loss. J Islamabad Med Dent Coll 2018;7(1):29–35.
Patel C, Green BD, Batt JM, Kholmurodova F, Barnes M, Geyer WJ, et al. Antibiotic prescribing for tonsillopharyngitis in a general practice setting. Aust J Gen Pract 2019;48(6):395–401.
Albarasi A. Effect of Postoperative Antibiotic on Postoperative Infection in Tonsillectomy Operations--Prospective Study at Benghazi Medical Center Between October 2012 and May 2013. Int J Otorhinolaryngol 2016;2(2):5–8.
Patel PN, Jayawardena AD, Walden RL, Penn EB, Francis DO. Evidence-based use of perioperative antibiotics in otolaryngology. Otolaryngol Head Neck Surg 2018;158(5):783–800.
Sandora TJ, Fung M, Melvin P, Graham DA, Rangel SJ. National variability and appropriateness of surgical antibiotic prophylaxis in US children’s hospitals. JAMA Pediatr 2016;170(6):570–6.
Cadd B, Rogers M, Patel H, Crossland G. (Ton) silly seasons? Do atmospheric conditions actually affect post-tonsillectomy secondary haemorrhage rates? J Laryngol Otol 2015;129(7):702–5.
Canche-Martín E, Lugo-Machado JA. Prevalence and factors associated with post-tonsillectomy bleeding. An Otorrinolaringol Mex 2018;63(1):40–5.
Manikandan D, Musarrat F, Preetham A, Anjali R. Measurement of blood loss during adenotonsillectomy in children and factors affecting it. Case Rep Clin Med 2015;4(5):151.
Spektor Z, Saint-Victor S, Kay DJ, Mandell DL. Risk factors for pediatric post-tonsillectomy haemorrhage. Int J Pediatr Otorhinolaryngol 2016;84:151–5.
Horwood J, Cabral C, Hay AD, Ingram J. Primary care clinician antibiotic prescribing decisions in consultations for children with RTIs: a qualitative interview study. Br J Gen Pract 2016;66(644):e207–13.
Fletcher-Lartey S, Yee M, Gaarslev C, Khan R. Why do general practitioners prescribe antibiotics for upper respiratory tract infections to meet patient expectations: a mixed methods study. BMJ Open 2016;6(10):e012244.
Ahmad R, Salam F, Khan AS, Bashir F, Raique A. Tonsillectomy in paediatric population; comparison of bipolar electrocautry and cold dissection method. Prof Med J 2016;23(4):499–503.
Boss EF, Mehta N, Nagarajan N, Links A, Benke JR, Berger Z, et al. Shared decision making and choice for elective surgical care: a systematic review. Otolaryngol Head Neck Surg 2016;154(3):405–20.
Douglas-Jones P, Fagan JJ. Tonsillectomy rates in the South African private healthcare sector. S Afr Med J 2016;106(11):1134–40.
Baloch MA, Akhtar S, Ikram M, Humayun HN. The rationality of prescribing antibiotics after tonsillectomy. J Pak Med Assoc 2012;62(5):445–7.
Khosa SH, Ahmad S, Rahi E. Prophylactic antibiotics for tonsillectomy. Pak J Med Health Sci 2015;9:989–91.
Al-Tamimi SF. Should antibiotics be mandatory in perioperative tonsillectomy and/or adenotonsillectomy? J Coll Physicians Surg Pak 2000;10(6):207–8.
Kullar R, Frisenda J, Nassif PS. The More the Merrier? Should Antibiotics be Used for Rhinoplasty and Septorhinoplasty?—A Review. Plast Reconstr Surg Glob Open 2018;6(10):1–8.
Yaseen MA, Ameen HH. The role of amoxicillin in preventing post-tonsillectomy complications. Zanco J Med Sci 2013;17(1):280–5.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.