Antibiotic prophylaxis in thyroid surgery: a preliminary multicentric italian experience

The benefits of this antibiotic prophylaxis is not supported by clinical evidence in the literature. We have conducted a multicentric randomized double-blind trial on 500 patients who had undergone thyroidectomy for goitre or thyroid carcinoma. The 500 patients enrolled in the study (mean age 47 years) were randomized in two subgroups of 250 patients. 250 patients were treated with standard antibiotic prophylaxis with sulbactam/ampicillin 1 fl (3 gr.) 30 min before surgery. No antibiotic prophylaxis was instituted in the remainder 250 patients. Our RCT showed that prophylactic antibiotic treatment is not beneficial in patients younger than eighty years old, with no concomitant metabolic, infective and hematologic disease, with no cardiac valvulopathies, not under steroidal or immunosuppressive treatment, and not severely obese. Our study should be regarded only as a preliminary RCT, and should be followed by a study in which a larger number of patients should be enrolled so that statistically significant data can be obtained.The rationale of systemic antibiotic prophylaxis is to reduce the incidence of surgical infections in the surgical site [1]. Antibiotic prophylaxis should be instituted only in clean-contaminated surgical procedures or in clean surgical procedures in which an infective complication could represent an occurrence of particular severity, or in clean procedures in which prosthetic implants or other exogenous materials are being used. Antibiotic prophylaxis is not indicated in clean surgical procedures where the potential risk of side effect, bacterial and/or mycotic superinfections and the emergence of bacterial resistant strains outweighs the possible advantages. Surgical procedures are classified into four types in correlation to the increasing risk of bacterial contamination and infection [2]:- clean surgical procedures (incidence of infections < 5%);- clean – contaminated surgical procedures (incidence of infections < 10%);- contaminated surgica