Antibiotic Prophylaxis in Thyroid and Parathyroid Surgeries: An Overkill

  • Background: Against international guidelines, prophylactic antibiotics are routinely used in thyroid and parathyroid surgeries in India. There are no published reports of such use from India.

    Methods: A retrospective analysis of the prophylactic antibiotic use in thyroid and parathyroid surgeries at our institute was done between January 2014 to December 2018.  87 patients underwent thyroid and parathyroid surgeries. 68 patients did not receive antibiotic prophylaxis while 19 patients received antibiotics (Cefuroxime, 1.5 gm). 40 patients (45%) had a drain. The average age of patients was 46 years and length of stay was 3 days. In the no-prophylaxis group, no patient developed infection, but in the prophylaxis group, one developed surgical site erythema. At our centre, multidrug resistance is common and most are sensitive to only Colistin. Indiscriminate use of antibiotics leads to resistance, the treatment of which costs US dollars 600.00 for 7 days which is very significant to patients from our country.

    Conclusion: We reiterate that antibiotic prophylaxis in clean surgeries like thyroid and parathyroid have no role, barring some selected cases. Drains did not increase the rate of infection, even in the group of patients not receiving prophylaxis. In a limited resource setting like ours, antibiotics add to the cost of treatment and increase the chances of developing secondary resistance. Proper sterile preparation of the surgical site can prevent infections in such surgeries to a large extent. A prospective randomized study with cost effective analysis on the use of antibiotic prophylaxis is needed.

 

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