Objective: To reconcile conflicting published reports regarding the clinical efficacy of postoperative antibiotics for reduction of posttonsillectomy morbidity.
Study design: Systematic review (meta-analysis).
Methods: Meta-analysis of seven randomized controlled trials of postoperative oral antibiotics in patients undergoing tonsillectomy or adenotonsillectomy. Postoperative pain and time to return to normal activity and diet were studied as distinct end points using a random effects model with weighted mean difference (RevMan 4.2). Search strategy included electronic searches of PubMed and Cochrane library databases; cross-referencing textbooks, reviews, and original trials; and contacting experts in the field.
Results: Subjects treated with antibiotics experienced an earlier return to a normal diet (-1.22 days; 95% confidence interval [CI] = -1.97, -0.48; P = .001) and an earlier return to normal activity (-0.99 days; 95% CI = -1.80, -0.17; P = .02). Evaluation of mean pain visual analogue scores (VAS 0-10) over the first 5 and 7 postoperative days failed to demonstrate any significant effect of antibiotic therapy (VAS difference over 5 days = 0.41; -1.18, 2.00; P = .61) (VAS difference over 7 days = -0.64; -3.46, 2.18; P = .66). Cost analysis suggests routine therapy may be cost-effective but did not include analysis of side effects or resistance resulting from antibiotic usage.
Conclusion: The results of this systematic meta-analysis suggest that postoperative oral antibiotics do not significantly reduce posttonsillectomy pain but result in an earlier return to normal activity and diet by approximately 1 day. Given the frequency that tonsillectomy is performed, this possible benefit should be weighed against the cost and potential side effects of routine antibiotic therapy.