title: [Rational approach of antibioprophylaxis: systematic review in ENT cancer surgery].
abstract: In head and neck cancer surgery antibiotic prophylaxis is effective in reducing the incidence of surgical site infections (SSI). However, controversies between antibiotic prophylaxis and curative antibiotic therapy exist, particularly when complex and decaying surgeries are performed in risky underlying conditions, with a risk of persisting salivary effusion in the postoperative period, or in the case of reconstruction with myo-cutaneous flaps. We have performed a systematic review of the literature according to PRISMA recommendations to answer the following questions: indications for antibiotic prophylaxis and curative antibiotic therapy, optimal duration, and choice of antibiotics for prophylaxis in head and neck cancer surgery. Literature analysis allows to conclude that patients undergoing Altemeier classes 2 and 3 surgical procedures should receive perioperative antibiotic prophylaxis restricted to the first 24 postoperative hours. No benefit has been shown with its extension beyond these 24 hours. The most adapted combinations of antibiotics in this setting are "amoxicillin+clavulanic acid" and "clindamycin+gentamicin". However, the level of evidence regarding the most decaying surgeries with high risk of SSI is low, making it necessary to perform new high-powered randomized trials in these patients. Eventually, it should be noted that antibiotic prophylaxis should be an integral part of SSI preventive measures, including application of hygiene measures, and postoperative monitoring of SSI clinical signs.
authors.affiliation: Département d'anesthésie et réanimation, hôpital Tenon, 4 rue de la Chine, Paris, France. marc.garnier@tnn.aphp.fr
authors.forename: M
authors.initials: M
authors.lastname: Garnier
authors.forename: C
authors.initials: C
authors.lastname: Blayau
authors.forename: J-P
authors.initials: JP
authors.lastname: Fulgencio
authors.forename: B
authors.initials: B
authors.lastname: Baujat
authors.forename: G
authors.initials: G
authors.lastname: Arlet
authors.forename: F
authors.initials: F
authors.lastname: Bonnet
authors.forename: C
authors.initials: C
authors.lastname: Quesnel
mesh_terms: D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D010039:Otorhinolaryngologic Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D005839:Gentamicins; D002981:Clindamycin; D019980:Amoxicillin-Potassium Clavulanate Combination