Prophylactic antibiotics fail to reduce infection rate following clean conventional myringoplasty

In this study, “Prophylactic antibiotics have no benefit for outcome in clean myringoplasty-A register-based cohort study from SwedEar”, co-author Maria Höglund said that the main objective of our research was To investigate whether prophylactic antibiotics (PA) in conjunction with myringoplasty of clean and uninfected ears reduces postoperative infections within six weeks after surgery, and whether it affects or not the healing rate of the tympanic membrane (TM) at follow-up, 6-24 months after surgery. We extracted data from The Swedish Quality Register for Ear Surgery (SwedEar), the years 2013-2019 noted.

The patients included had registered clean conventional myringoplasty with follow-up visits.

The primary outcome measures included in the study were the effect of PA use on TM healing rate at follow-up and postoperative infection within six weeks of surgery.

The results of the study are:

• There were 1665 participants in the study group.
• At follow-up, 86.2% had a healed tympanic membrane.
• They reported no significant difference between the groups with/ without PA administration constituting 87.2% and 86.1%, respectively.
• Within six weeks, 8.0% had a postoperative infection.
• In the group receiving prophylactic antibiotics, 10.2 %had Postoperative infection compared with 7.7% of the group that did not receive PA.
• Postoperative infection within six weeks reduced the frequency of healed TMs.

They explained that PA treatment is used worldwide in myringoplasty, but there is no evidence of whether it is associated with the rate of healing and infection. Does PA improve the healing rate? Does it decrease the healing rate?

Answering these questions, our study found that PA administered during clean conventional myringoplasty does not improve the chance of having a healed TM at follow-up nor decreases the risk of postoperative infection within six weeks after surgery.

Our study had limitations; follow-up data were absent in 1414 subjects.

The manuscript was supported by the County Council of Västernorrland, Sundsvall, Sweden, Umeå University, Umeå, Sweden they acknowledged.

Further reading:

Westman E, Höglund M, Nilsson FB, Bonnard Å, Englund E, Eriksson PO. Prophylactic antibiotics have no benefit for outcome in clean myringoplasty-A register-based cohort study from SwedEar. Clin Otolaryngol. 2023 Aug 9. doi 10.1111/coa.14089. Epub ahead of print. PMID: 37555629.