Postoperative Oral Antibiotics and Sinonasal Outcomes Following Endoscopic Transsphenoidal Surgery for Pituitary Tumors Study: A Multicenter, Prospective, Randomized, Double-Blinded, Placebo-Controlled Study. Issue 5 (19th August 2021)

• Record Type: Journal Article
• Authors: Little, Andrew S; Kshettry, Varun R; Rosen, Marc R; Rehl, Ryan M; Haegen, Timothy W; Rabinowitz, Mindy R; Nyquist, Gurston G; Recinos, Pablo F; Sindwani, Raj; Woodard, Troy D; Farrell, Christopher J; Santarelli, Griffin D; Milligan, John; Evans, James J
• Is Part Of: Neurosurgery. Volume 89:Issue 5(2021)
• Page Start: 769
• Page End: 776
• Publication Date: 2021-08-19
• Subjects: Antibiotics -- Pituitary adenoma -- Pituitary surgery -- Quality of life -- Sinusitis; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyab301
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Postoperative prophylactic antibiotics are commonly used in pituitary surgery, but evidence supporting their use is lacking, which has implications for antibiotic stewardship. OBJECTIVE: To evaluate whether receipt of postoperative oral antibiotics results in superior sinonasal quality of life (QOL) compared with placebo among patients who undergo endoscopic endonasal transsphenoidal pituitary surgery. METHODS: Patients were randomized to receive either oral placebo or cefdinir (trimethoprim-sulfamethoxazole in patients intolerant to cefdinir) for 7 d after surgery. They were monitored for 12 wk. The primary outcome measure was sinonasal QOL at 2 wk on the Anterior Skull Base Nasal Inventory-12. Supplementary end points included sinonasal QOL reported on the Sinonasal Outcome Test-22 and objective endoscopy scores to assess nasal healing according to the Lund-Kennedy method. RESULTS: A total of 461 patients were screened, 131 were randomized, and 113 (placebo arm: 55; antibiotic arm: 58) were analyzed. There was no clinically meaningful or statistically significant difference in sinonasal QOL at any measured time point ( P ≥ .24) using either instrument. Nasal cavity endoscopy scores were not significantly different at 1 to 2 wk after surgery ( P = .25) or at 3 to 4 wk after surgery ( P = .08). CONCLUSION: Postoperative prophylactic oral antibiotics did not result in superior sinonasal QOL compared with placebo among patients who underwent standard endoscopic transsphenoidal surgery. Graphical Abstract: