Guidelines on Using Perioperative Antibiotics in Otolaryngology – Head and Neck Surgery


  • To identify and clarify current evidence supporting and disputing the effectiveness of perioperative antibiotic use for common otolaryngology procedures.


    • This study reviewed published studies evaluating the use of perioperative oral or IV antibiotics in common otolaryngology surgical procedures.
    • The study excluded the review of studies assessing the use of ear drops, irrigations, powders, etc (non-oral or IV antibiotics).
    • Perioperative was defined in this study as antibiotics given either preoperatively (>60 minutes prior to incision and induction of anesthesia), intraoperatively (at induction of anesthesia or within 60 minutes of incision) or postoperatively (antibiotics given a duration of time after immediately surgery).
    • 7671 studies were found initially with 180 meeting criteria.
  • Procedures looked at were tonsillectomy, septoplasty, rhinoplasty, endoscopic sinus surgery, clean and clean-contaminated otologic procedures, anterior and lateral skull base procedures, and clean and clean-contaminated head and neck surgery.


  • Tonsillectomy: Reviewed 27 studies for tonsillectomy, which are clean-contaminated procedures, and although results of the studies were variable, this current study recommended that no perioperative antibiotic use is necessary when looking at postoperative fevers, pain control, days until return to normal diet, foul odor from mouth, bleeding, or infection.
  • Septoplasty and Rhinoplasty: Reviewed 16 studies for septoplasty and rhinoplasty, which are clean-contaminated procedures, and recommend that no perioperative antibiotic use is necessary for septoplasty and simple rhinoplasty. Complex rhinoplasty was defined as revision or needing the use of grafting material. For complex rhinoplasty, this study recommended giving intraoperative AND postoperative antibiotics (<24 hours). It should be noted that this study required included papers to only have nasal packing in for <48 hours so if patients will have nasal packings for >48 hours, the recommendations of this study may not apply.
  • Endoscopic Sinus Surgery: Reviewed 10 studies for endoscopic sinus surgery, which is a clean-contaminated procedure, and recommend that no perioperative antibiotic use is necessary for endoscopic sinus surgery when looking at rates of infection. However, this may not apply to patients who are going to have nasal packing/splints for >48 hours.
  • Otological Surgery: Reviewed 16 studies for otologic surgery. For clean otologic procedures, it is recommended that no perioperative antibiotic use is necessary when looking at infection rates, drainage, and graft failure. When looking at clean-contaminated procedures (cholesteatoma or drainage), intraoperative antibiotic use was found to be useful. For cochlear implants, it is recommended that a single intraoperative dose of antibiotics should be given due to the potentially devastating effects of infection. 
  • Skull base/neurotologic surgery: Reviewed 30 studies for skull base procedures, and recommend intraoperative and postoperative antibiotics for less than 24 hours for anterior skull base procedures (clean-contaminated) and intraoperative antibiotics for lateral skull base cases (clean).
  • Head and neck surgery: Reviewed 83 studies for head and neck surgeries. Procedures were broken down into clean procedures and clean-contaminated (those involving the aerodigestive tract). For clean cases (including salivary gland procedures), it is recommended that no perioperative antibiotic use is necessary. When looking at neck dissections, even though considered clean, it is recommended that <24 hours of antibiotic use is optional due to discordant data. When looking at clean-contaminated procedures, including microvascular free flaps, it is recommended that 24-48 hours of antibiotics (intraoperative and perioperative) be used.


Patel PN, Jayawardena ADL, Walden RL, Penn EB, Francis DO. Evidence-Based Use of Perioperative Antibiotics in Otolaryngology. Otolaryngol Head Neck Surg. 2018;:194599817753610.