What are the prophylactic antibiotics for rhinoplasty (nose surgery)?

From the Guidelines

Prophylactic antibiotics should be administered to all patients undergoing nose surgery to reduce the risk of postoperative infection. When it comes to nose surgery, the use of prophylactic antibiotics is a crucial aspect of preventing surgical site infections.

• The American College of Cardiology Foundation/American Heart Association task force on practice guidelines recommends the use of prophylactic antibiotics in patients undergoing surgery, including nose surgery 1.
• A first- or second-generation cephalosporin is recommended for prophylaxis in patients without methicillin-resistant Staphylococcus aureus colonization, as stated in the 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary 1.
• For most rhinoplasty and septoplasty procedures, a single preoperative dose of a first-generation cephalosporin such as cefazolin (1-2g IV) administered 30-60 minutes before incision is typically sufficient.
• The choice of antibiotic should target the most common pathogens in nasal surgeries, primarily Staphylococcus aureus and streptococcal species.
• Extended antibiotic prophylaxis beyond 24 hours after surgery is usually not necessary for clean or clean-contaminated nasal procedures unless there are specific risk factors such as immunosuppression or placement of foreign materials.
• Proper timing of administration is crucial to ensure adequate tissue concentrations during surgery, as emphasized in the guideline 1.
• Some surgeons may prescribe a short postoperative course of oral antibiotics such as cephalexin (500mg four times daily) or amoxicillin-clavulanate (875/125mg twice daily) for 3-5 days, particularly for more extensive procedures.

From the FDA Drug Label

To prevent postoperative infection in contaminated or potentially contaminated surgery, recommended doses are: 1 gram IV or IM administered 1/2 hour to 1 hour prior to the start of surgery. For lengthy operative procedures (e.g., 2 hours or more), 500 mg to 1 gram IV or IM during surgery (administration modified depending on the duration of the operative procedure). 500 mg to 1 gram IV or IM every 6 to 8 hours for 24 hours postoperatively

The recommended dose of cefazolin for perioperative prophylactic use in nose surgery is 1 gram IV or IM administered 1/2 hour to 1 hour prior to the start of surgery, with possible additional doses during and after surgery depending on the procedure's duration and complexity 2.

From the Research

Nose Surgery and Antibiotic Prophylaxis

• The use of antibiotic prophylaxis in nose surgery, such as rhinoplasty, is a common practice to prevent surgical site infections 3, 4, 5, 6.
• A study published in 2020 found that preoperative screening using repeated nasal swab cultures, followed by appropriate antibiotic prophylaxis and topical antibiotic decolonization, may reduce surgical-site infection in complicated septorhinoplasty 3.
• Another study published in 2019 found that there was no significant difference in the occurrence of postoperative infections between short-course and extended-course antibiotic prophylaxis after ear, nose, throat, and oral and maxillofacial surgery 4.
• A review of 363 consecutive cases of rhinoplasty found that the overall infection rate was 3.0%, with coliforms accounting for 45.5% of postoperative infections and Staphylococcus aureus responsible for 36.4% of infections 5.
• A systematic review and meta-analysis published in 2019 found that the pooled evidence from 5 randomized controlled trials did not support the use of preventive antibiotic therapy in rhinoplasty 6.

Microbiology and Antibiotic Prophylaxis

• The microbial flora of patients undergoing septorhinoplasty includes normal flora, Staphylococcus aureus, and fecal coliforms 5.
• Patients with adult acne were found to have an increased incidence of colonization with fecal coliforms, while patients with diabetes were found to have an increased incidence of colonization with Staphylococcus aureus 5.
• The use of antibiotic prophylaxis should be based on the microbiology of the patient's nasal flora and the specific surgical procedure being performed 3, 5.

Perioperative Strategies for SSI Prevention

• Perioperative nurses employ a variety of evidence-based best practices to prevent surgical site infections, including hand hygiene, preoperative patient skin antisepsis, and antimicrobial irrigation 7.
• The use of antibiotic prophylaxis is just one part of a comprehensive strategy to prevent surgical site infections 3, 4, 7, 5, 6.