👉Surgical site infection is a rare complication after routine transcervical thyroidectomy, with a reported incidence of 0.09% to 2%.
👉In a small European study, preoperative antibiotic administration did not affect the incidence of surgical site infection.
👉Antimicrobial prophylaxis (AMP) for clean surgery of the head and neck was not recommended in a 1999 pharmacy guideline, with moderate strength of evidence.
👉A recent single-institution randomized trial confirmed the safety of clean thyroid and parathyroid surgery without AMP.
👉However, routine AMP is still commonly used for clean thyroid and parathyroid surgeries in Japan and many other countries; according to an international survey of 275 endocrine surgeons, 26% administered AMP “almost always”, particularly in Asia (59%).
👉Because both preoperative (obesity, alcohol use) and intraoperative factors (ie, operative time, airway injury) are associated with infection, high-risk patients may benefit from selective use of AMP, in which case gram-positive coverage should be administered before or on induction.
👉With rare exceptions, postoperative AMP is not indicated.
👉Recommendation 19 AAES: Antimicrobial prophylaxis is not necessary in most cases of standard transcervical thyroid surgery. (Strong recommendation, high-quality evidence)
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