Prophylactic Perioperative Antibiotic Use in Endoscopic Sinus Surgery: A Systematic Review and Meta-analysis

Context. Perioperative antibiotics are widely used to improve the outcomes of endoscopic sinus surgery. Objective. The aim of this study was to summarize the evidence on the effect of perioperative antibiotic prophylaxis on outcomes of endoscopic sinus surgery. Data Sources and Review Methods. We searched electronic databases from inception through May 2011 for any relevant clinical trials or observational studies. Two reviewers working independently extracted study characteristics, quality, and the outcomes of interest. Random-effects meta-analysis was used to pool the relative risks (RRs) and the standardized mean differences (SMDs) across trials. Results. We found 4 eligible trials with varying quality, of which 3 were included in the quantitative analysis. Antibiotic prophylaxis was associated with a nonsignificant reduction in the incidence of infections (relative risk, 0.76; 95% confidence interval [CI], 0.64 to 1.09), symptoms scores (SMD, -0.04; 95% CI, -0.46 to 0.38), and endoscopic scores (SMD, -0.09; 95% CI, 0.30 to 0.13). The heterogeneity associated with the analysis was significant only for the outcome of change in symptoms score (I-squared values, 0%, 70%, and 0% for the 3 outcomes, respectively). Conclusions. Trial data available to date are unable to demonstrate a statistically significant reduction in infection, symptom scores, or endoscopic scores to support the routine use of postoperative prophylactic antibiotics following endoscopic sinus surgery. Our analysis was limited by the number of published trials related to this topic.