17th June 2013

Antibiotics in rhinoplasty

I was most interested to note today that the G8 summit is going to be discussing world use of antibiotics.  Inappropriate use of antibiotics can lead to the development of antibiotic resistance in bacteria meaning infections can’t be treated with the antibiotics we currently have.  Antibiotics can also lead to life threatening inflammation of the intestine (pseudomembranous colitis).

In rhinoplasty infection can be devastating causing tissue destruction and nasal deformity despite good surgery.  Delicate handling of tissues helps minimise tissue injury and risk of infection but can never make infection risk zero.

We aim always to make surgical technique precise, minimally traumatic and as delicate as possible.  We use intravenous antibiotics when surgery starts and also use antibiotics to rinse the tissues and any grafts too.

We have been giving antibiotics after surgery as tablets too but it’s possible that this isn’t necessary.  Orthopaedic surgeons don’t give antibiotic tablets after surgery any longer and nor do surgeons operating on the bowel.  Whilst nasal surgery and rhinoplasty can’t directly be compared with these types of surgery, particularly as normal noses have a lot of bacteria inside them, it’s still important that we’re not using antibiotics unnecessarily.

It’s very difficult to do clinical studies comparing the outcome of patients undergoing rhinoplasty with and without antibiotics as fortunately infection is still rare which would mean we need a lot of patients in the studies and also no two rhinoplasties are the same making it again difficult to compare.

I’ve looked at the plastic surgery scientific literature particularly a paper by Dr Collins in the Journal of Plastic and Reconstructive Surgery from this year.  I have decided therefore that best practice now means that antibiotics should be administered within one hour before incision, they must be appropriate for the nose and they should be discontinued within 24 hours of the end of surgery.  We’ve therefore decided it’s best practice not to provide antibiotic tablets after surgery unless there is a special indication.  We will still be using antibiotic ointments, solutions and creams to the nose after surgery.