Adult
Cancer, head & neck, after excision
After excision of head & neck cancer or radical neck dissection, routine post-operative antibiotic therapy is NOT recommended.
For a few cases, antimicrobial treatment may be considered when operating on an infected area or rarely, where there is heavy contamination of surgical sites, such as:-
- Anastamotic salivary leak
- Pharyngeal excision
- Surgical site infection
Review the need for antibiotics daily post op and aim to stop within 72 hours.
Antibiotics should NOT be prescribed for patients "awaiting a swallow test" or "until drains out".
Agents with lower risk of resistance and Clostridioides difficile Infection (CDI) (i.e.WHO AWaRe Classification 'Access' group) are preferred.
See also: antibiotic guidelines for serious deep neck space infections occurring after head and neck cancer surgery
Preferred
amoxicillin 500mg po tds (iv if NBM)
Alternative
For penicillin allergy (non-severe)
cefalexin 500mg po tds OR cefazolin 1g iv tds
For penicillin allergy (severe) Or for MRSA positive patients:
co-trimoxazole 960mg po bd (iv if NBM)