Antibiotic prophylaxis for patients undergoing rhinologic surgeries: a survey of Belgian otorhinolaryngologists

BACKGROUND: As antibiotic prophylaxis prescribing practices in rhinologic surgeries are heterogeneous, given the paucity of evidence, we aimed at mapping the current practice in our country and identify trends in prescribing patterns. METHODS: A 10-item anonymized survey asking about surgeon’s characteristics as well as his/her prescription habits was electronically sent out to 838 members of the Belgian ENT Society. Prescribing patterns were analyzed and associations with the different variables were calculated. RESULTS: Among 126 responders, our analysis revealed a tendency towards overprescription of prophylactic antibiotics compared to the available recommendations. Practice environment was an important determinant for antibiotic prophylaxis prescription since academic ENTs prescribed significantly fewer prophylactic antibiotics for septoplasty, closed rhinoplasty and open rhinoplasty compared to private practice ENTs. Also, geographic region of practice was a significant determinant with French-speaking surgeons being more likely to prescribe antibiotic for septoplasty and functional endoscopic sinus surgery (FESS) compared to Dutch-speaking surgeons. The use of packing was significantly associated with antibiotic prophylaxis for, but not for septoplasty nor rhinoplasty. 70.6% justified prescription by the fear of post-operative infection. 39.7% of the respondents mentioned being aware of current recommendations, while we found that only 6.3% adhered to all of them. CONCLUSION: This study demonstrates the inconsistency of prophylactic antibiotic prescribing among rhinologic surgeons, with a tendency to overprescribing compared to peri-operative prophylactic recommendations. These issues should be explored further to build evidence-based guidelines for optimizing antibiotic prophylaxis.