What is the perioperative antibiotic prophylaxis in adult oncologic head and neck surgery?

BACKGROUND The goal of antibiotic prophylaxis is not to sterilize the operative field, but to minimize the perioperative bacterial load to the level that will not result in clinical infection. Patient-related risk factors, such as poor nutritional status, smoking, diabetes and impaired immune system, and nature of the surgery should be reviewed when considering prophylactic use of antibiotics. Postoperative surgical site infections (SSIs) occur in <1% of patients undergoing clean head and neck operations, such as uncontaminated thyroidectomy, parotidectomy, or submandibular gland excision. Therefore, antibiotic prophylaxis is not thought to be beneficial. It is required though for patients at risk for development of infective endocarditis. According to the American Heart Association, prophylaxis should be administered to high-risk and offered to moderate-risk patients (Table I). Based on the available evidence, breach of a mucosal barrier in clean-contaminated cases requires antimicrobial prophylaxis, as it decreases SSIs substantially. The controversy on choice and duration of antibiotic regimen remains.