Perioperative antibiotic practices amongst otorhinolaryngologists (ear, nose and throat surgeons) in South Africa.

Background: The primary goal of perioperative antibiotics is to reduce the rate of surgical site infections (SSI); however, in certain surgical procedures, the use of perioperative antibiotics has been shown to have no impact on the rate of SSI. Inappropriate use of antimicrobials increases cost, potential side effects and further promotes antibiotic resistance. This study aims to provide insight into the adherence of South African otorhinolaryngologists to available evidence-based international guidelines.

Methods: An electronic survey was sent to otorhinolaryngologists in South Africa.

Results: Ninety-two respondents indicated that they utilise the following resources to guide their decisions regarding perioperative antibiotic prescribing - anecdotal evidence 27% (25/92), practices of the surgeon's postgraduate training unit 28% (26/92), published international guidelines 28% (26/92), recommendation of their local hospital's microbiologists 14% (13/92). Respondents indicated they take the following factors into consideration to guide decisions regarding perioperative antimicrobial use - 48% (35/92) duration of surgery, 85% (78/92) degree of contamination of the surgical field, 8% (7/92) patient's age, 8% (7/92) degree of blood loss, 22% (20/92) HIV status of patient, and 22% (20/92) patient's access to hospital. Thirty-five per cent (32/92) of respondents indicated they audit their own rate of wound complications.

Conclusion: There is significant heterogeneity in the use of perioperative antibiotic prescribing practices and variable adherence to international consensus guidelines amongst ENT surgeons in South Africa. In light of the global increase in antibiotic resistance, this study highlights the need for increased awareness regarding the principles of antibiotic stewardship, pre-existing evidence-based guidelines and the need for a locally-generated South African otorhinolaryngology consensus guideline that promotes safe and rational use of perioperative antibiotic prophylaxis.