Prophylactic Antibiotic Practices in Common Otologic Surgeries in Iran

Rational surgical antibiotic prophylaxis is suggested for some selected surgical processes. However, inappropriate utilization of antimicrobial prophylaxis reduces benefits and increases costs and risks, such as antibiotic resistance. This study aimed to evaluate the current practice of antibiotics prescribed by surgeons in common otologic surgeries. This cross-sectional study was conducted among otolaryngologists with at least 5 years of experience in common otologic surgeries (tympanoplasty, tympanomastoidectomy, stapes, or middle ear exploration (MEE) surgeries). A total of 257 otolaryngologists filled a checklist about their selected regimen and timing of antibiotic(s) administration. The rates of antibiotic prophylaxis prescription in dry and wet ears in tympanoplasty were 7.4% and 87.1% (preoperative), 40.9% and 47% (intraoperative), 88.3% and 98% (postoperative); in tympanomastoidectomy with no cholesteatoma were 7.1% and 97.8% (preoperative), 39.6% and 50.9% (intraoperative), 93.7% and 99.6% (postoperative); in tympanomastoidectomy with cholesteatoma were 14% and 98.3% (preoperative), 45.4% and 51.9% (intraoperative), 98.3% and 99.6% (postoperative), respectively, and in stapes or MEE surgeries were 6.4% (preoperative), 41.7% (intraoperative) and 73.1% (postoperative), respectively. There were no significant differences in the rates of prescribing intraoperative prophylaxis between wet and dry ears, except in tympanomastoidectomy without cholesteatoma. Overall, the most prescribed antibiotics were cephazolin, cephlexin, and ciprofloxacin drop.The results of this study revealed the inappropriate administration and timing of antibiotic prophylaxis regarding current literature evidence. Despite the lack of evidence on the potential role of antibiotic prophylaxis in clean-contaminated and contaminated ears, a significant number of surgeons prescribed prophylactic antibiotics in tympanoplasty and tympanomastoidectomy without cholesteatoma.