PRS-GO Plastic and Reconstructive Surgery Global Open · 2018

The More the Merrier? Should Antibiotics be Used for Rhinoplasty and Septorhinoplasty?-A Review

Kullar R, Frisenda J, Nassif PS.

PubMed 30534507 Publisher (DOI)Free full text (PMC)

What this paper says

Reviewing 10 studies, the authors conclude antibiotics do not reduce infection in straightforward rhinoplasty, while in complex revision cases postoperative antibiotics cut the infection rate from 27 percent to 8 percent.

Overview

Antibiotic resistance makes unnecessary prescribing a concern across surgery. Following the first guidelines on rhinoplasty from the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the authors searched MEDLINE for evidence on whether systemic antibiotics help in rhinoplasty and septorhinoplasty.

Sections of note

MEDLINE search through PubMed using rhinoplasty, septorhinoplasty, infection, antimicrobials, and antibiotics; 10 studies met criteria.
Studies of antibiotics given around the time of surgery showed similar infection or bacteremia rates, 0 to 13.3 percent, whether or not antibiotics were given.
No patients experienced significant local or systemic infections regardless of antibiotic use.
In 3 studies of postoperative antibiotics, antibiotics reduced infection from 27 percent to 8 percent in complex revision cases.
In noncomplex cases, a single preoperative dose gave infection rates no different from a preoperative dose plus 7 days afterward, and the longer course produced more antibiotic-related adverse events and higher costs.
Recommended agents for those with other health conditions or complex surgery: a first-generation cephalosporin such as cefazolin, or clindamycin if allergic to beta-lactams.
If given around surgery, antibiotics should be started within 1 hour of the incision and stopped within 24 hours.

What it means for a patient

A week of antibiotics after a routine rhinoplasty gave no infection benefit and caused more side effects.
Complex revision surgery is the situation where postoperative antibiotics did reduce infection.
Infection after routine rhinoplasty is uncommon whether or not antibiotics are given.
Limits: only 10 studies, of varying design, and the authors state further research is needed on optimal duration in complex cases.

Why this paper matters

Prolonged antibiotic courses after rhinoplasty remain common practice without supporting evidence. This review separates the routine case, where they are not warranted, from the complex revision, where they are. The evidence base is thin and the optimal course length in complex cases is unresolved.

Terms

Perioperative: Around the time of the operation.
Bacteremia: Bacteria present in the bloodstream.
Cephalosporin: A class of antibiotic; cefazolin is a first-generation example.
Beta-lactam: The antibiotic family including penicillins and cephalosporins.
Antimicrobial resistance: Bacteria becoming able to survive the drugs used against them.

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

Abstract

Background: With antimicrobial resistance a global threat, optimizing antibiotic usage across the surgical continuum is vital. The American Academy of Otolaryngology-Head and Neck Surgery Foundation recently published the first guidelines addressing management in rhinoplasty. The authors reviewed pertinent literature on the role of systemic antibiotics in rhinoplasty and septorhinoplasty.

Methods: The authors performed a MEDLINE search through PubMed using the key terms rhinoplasty, septorhinoplasty, infection, antimicrobials, and antibiotics.

Results: Ten studies met criteria. Studies evaluating antibiotics perioperatively showed similar infection and/or bacteremia rates (0-13.3%) in those receiving or not receiving antibiotics. No patients experienced significant local/systemic infections regardless of antibiotic use. In the 3 studies evaluating antibiotics postoperatively, antibiotics decreased the infection rate from 27% to 8% in complex revision cases. In a study evaluating postoperative antibiotics in noncomplex cases, there were no significant differences in infection rates between those receiving only a preoperative dose and those receiving preoperative in addition to 7 days of postoperative antibiotics, with the latter experiencing higher rates of antibiotic-related adverse events and costs.

Conclusions: Peri- and postoperative antibiotics in noncomplex rhinoplasty and septorhinoplasty are not beneficial in decreasing infection risk. Antibiotics, with a first-generation cephalosporin such as cefazolin (non-β-lactam, such as clindamycin, if β-lactam allergy), should be considered in patients with comorbidities/undergoing complex surgery. If perioperative antibiotics are used, antibiotics should be administered within 1 hour of incision and discontinued within 24 hours of the operation. Further research is warranted to evaluate the optimal duration of postoperative antibiotics in complex cases.

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