title: Antibiotic Use in Primary Palatoplasty: A Survey of Practice Patterns, Assessment of Efficacy, and Proposed Guidelines for Use.
abstract: BACKGROUND
  The literature provides no guidelines for antibiotic use in palatoplasty. The authors sought to ascertain practice patterns; review a large, single-surgeon experience, and propose guidelines for antibiotic use in primary palatoplasty.
  
  
  METHODS
  A six-question survey was e-mailed to all surgeons of the American Cleft Palate-Craniofacial Association. A retrospective study was also conducted of the senior author's 10-year primary palatoplasty series, and two groups were studied. Group 1 received no antibiotics. Group 2 received preoperative and/or postoperative antibiotics.
  
  
  RESULTS
  Three hundred twelve of 1115 surgeons (28 percent) responded to the survey. Eighty-five percent administered prophylactic antibiotics, including 26 percent who used a single preoperative dose. A further 23 percent gave 24 hours of postoperative therapy; 12 percent used 25 to 72 hours, 16 percent used 4 to 5 days, and 12 percent used 6 to 10 days. Five percent of surgeons administered penicillin, 64 percent administered a first-generation cephalosporin, 13 percent administered ampicillin/sulbactam, and 8 percent gave clindamycin. The authors reviewed 311 patients; 173 receive antibiotics and 138 did not. Delayed healing and fistula rates did not differ between groups: 16.8 percent versus 15.2 percent (p = 0.71) and 2.9 percent versus 1.4 percent (p = 0.47), respectively. A single patient treated without antibiotics developed a postoperative bacteremia. This case did not meet the Centers for Disease Control definition of a surgical site infection, but the patient developed a palatal fistula.
  
  
  CONCLUSIONS
  Antibiotic use in primary palatoplasty varies widely. The authors' data support a clinician's choice to forego antibiotic use; however, given the significance of palatal fistulae and the single case of postoperative streptococcal bacteremia, the study group recommends a single preoperative dose of ampicillin/sulbactam. Current evidence cannot justify the use of protracted antibiotic regimens.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: St. Petersburg, Fla.; Baltimore, Md.; and Pittsburgh, Pa. From the Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical School; the Divisions of Pediatric Plastic Surgery and Pediatric Infectious Diseases, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center; and the Department of Surgery, Allegheny General Hospital.
authors.forename: S Alex
authors.initials: SA
authors.lastname: Rottgers
authors.forename: Liliana
authors.initials: L
authors.lastname: Camison
authors.forename: Rick
authors.initials: R
authors.lastname: Mai
authors.forename: Sameer
authors.initials: S
authors.lastname: Shakir
authors.forename: Lorelei
authors.initials: L
authors.lastname: Grunwaldt
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Nowalk
authors.forename: Megan
authors.initials: M
authors.lastname: Natali
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Losee
mesh_terms: D019072:Antibiotic Prophylaxis / Q000592:standards*; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
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