Evaluation of Antibiotic Prophylaxis in Rhinoplasty: A Systematic Review and Meta-analysis

Nuyen B, Kandathil CK, Laimi K, Rudy SF, Most SP, Saltychev M.

PubMed 30489601 Publisher (DOI)Free full text (PMC)

What this paper says

Pooling 5 randomized trials with 589 participants, preventive antibiotics given before or after rhinoplasty made no significant difference to infection, with a pooled risk ratio of 0.92.

Overview

Prescribing antibiotics around rhinoplasty is widespread but the evidence has been disputed and never pooled. This systematic review searched six databases from inception, restricted inclusion to randomized trials in adults, and combined the results statistically.

Sections of note

Databases searched on February 16, 2018: MEDLINE, Embase, CINAHL, Cochrane Central, Scopus, and Web of Science, from inception, with no language or date restriction.
Inclusion: randomized clinical trials in adults aged 18 or over undergoing rhinoplasty, receiving systemic antibiotics with no other indication.
Three intervention types were defined: a single dose within 24 hours before incision; multiple doses started before and continued after; and antibiotics started within 24 hours after incision.
Data extraction followed PRISMA guidelines and the Cochrane Handbook, with two independent reviewers.
262 records were identified; only 5 randomized trials met the criteria, giving a pooled sample of 589 participants.
No significant difference was found for preventive antibiotics given preoperatively or postoperatively: pooled risk ratio 0.92, 95% CI 0.35 to 2.43, P .86.
The authors state this is the first Cochrane-protocol systematic review and meta-analysis on the question. Level of evidence 1.

What it means for a patient

Across the randomized evidence available, antibiotics around rhinoplasty did not reduce infection.
Only 5 trials and 589 patients exist on this question, so the confidence interval is wide, from 0.35 to 2.43.
A wide interval means a real benefit or harm has not been ruled out, only that none was detected.
Antibiotic use carries side effects and contributes to resistance, which is why the absence of demonstrated benefit matters.

Why this paper matters

This is the highest level of evidence available on a very common practice, and it does not support routine prophylaxis. It also documents how thin the randomized evidence base is. Larger trials would be needed to detect a small effect or to address complex revision cases separately.

Terms

Antibiotic prophylaxis: Antibiotics given to prevent infection rather than treat one.
Meta-analysis: Statistically combining the results of multiple studies.
Randomized clinical trial: A study assigning patients to treatments by chance.
Risk ratio: The risk in one group divided by the risk in another; 1 means no difference.
PRISMA: A standard set of reporting rules for systematic reviews.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Importance: Although antibiotic prophylaxis following rhinoplasty is widespread, the evidence on antibiotic prophylaxis effectiveness and the superiority of particular administration regimens is controversial. To date, a meta-analysis on the topic has not been performed.

Objective: To systematically review the association between use of preventive antibiotics and postoperative complications in patients undergoing rhinoplasty and quantify the review through meta-analysis.

Data Sources: MEDLINE, Embase, CINAHL, Central (Cochrane Controlled Register of Trials), Scopus, and Web of Science were searched with prospectively designed search phrases on February 16, 2018. All databases were searched from database inception. Key search terms included rhinoplasty, nasal valve repair, and antibacterial agent.

Study Selection: Randomized clinical trials (RCTs) with adults (≥18 years) undergoing rhinoplasty and including systemic antibiotic medications administered in the absence of other reasons for use of an antibiotic (eg, localized or systemic infection), without restrictions on language or the time of publication, were included in the study. Interventions of interest were classified into 3 types: (1) single-dose systemic antibiotic administered within 24 hours before the first incision, (2) multidose systemic antibiotic treatment started within 24 hours before the first incision and continuing after the operation, and (3) systemic antibiotic therapy (single dose or multidose) started within 24 hours after the first incision. The following comparisons were made: for the interventions of type 1, no antibiotic; for the interventions of types 2 or 3, no antibiotic or an intervention of type 1.

Data Extraction And Synthesis: Data extraction was compliant with PRISMA guidelines and Cochrane Handbook for Systematic Reviews of Interventions. Two independent reviewers assessed the relevance of the remaining records at abstract and full-text stages. Meta-analysis pooled with random-effects model.

Main Outcomes And Measures: Difference in infectious complication rate between groups.

Results: A total of 262 records were identified; of these, only 5 RCTs fulfilled predetermined population, intervention, comparison, and outcome criteria. The pooled study sample consisted of 589 participants. No significant differences in outcome of preventive antibiotic therapy given either preoperatively or postoperatively were found, with a pooled risk ratio of 0.92 (95% CI, 0.35-2.43; P = .86).

Conclusions And Relevance: This study appears to be the first Cochrane-protocol systematic review and meta-analysis investigating preventive antibiotics in rhinoplasty. This study's results suggest that pooled evidence from the 5 RCTs does not support the use of preventive antibiotic therapy in rhinoplasty.

Level Of Evidence: 1.

Abstract as indexed by PubMed; the article is open access (PubMed Central).