Mutiso Musyoka D, Macharia Isaac M
Department of otolaryngology, University of Nairobi, Nairobi, Kenya.
BMC Ear Nose Throat Disord. 2011 Sep 30;11:9. doi: 10.1186/1472-6815-11-9.
Adenotonsillectomy results in postoperative morbidity which otolaryngologists attempt to reduce by use of antibiotics. The regimes used as quite varied with some opting for a full oral course postoperatively while others prefer prophylactic doses. This randomised clinical trial done in Kenyatta National Hospital, Kenya had the aim of comparing the efficacy of Co-Amoxiclav given as a single intravenous dose with a full oral course in the prevention of post adenotonsillectomy morbidity.
126 patients below 12 years scheduled to undergo adenotonsillectomy were randomised into two groups. 63 were given a single intravenous dose of Enhancin [Co-Amoxiclav] at induction while the remaining half received a five days oral course of the same postoperatively. All received oral Pacimol [Paracetamol] in the postoperative period. Analysis was done and comparison made between the two groups with regards to pain, fever and diet tolerated in the postoperative period with a follow up period of seven days.
There was no statistical significant difference between the two groups with regards to postoperative pain, fever and diet tolerated. All had a P-value > 0.2. Postoperative pain was highest in the first postoperative day and reduced progressively to the lowest level on the 7th postoperative day. As pain reduced, patients were able to tolerate a more solid diet with all but 6 tolerating their usual diet. 4 patients developed fever in the 1st postoperative day which did not progress to the next day. One patient had fever on the 4th and 7th postoperative day and was admitted in the paediatrics' ward with a chest infection. All these patients with history of fever were in the group that was on oral postoperative Co-Amoxiclav.
A single intraoperative dose of Co-Amoxiclav given intravenously at induction was found to be just as effective as a full oral course of the same given postoperatively in the prevention of post adenotonsillectomy morbidity. The prophylactic dose is favoured over the later as it is cheaper, ensures compliance and relieves off the need for refrigeration of the oral suspension as not all have access to refrigeration in low economy countries as ours.
ClinicalTrials.gov: NCT01267942.
腺样体扁桃体切除术会导致术后发病，耳鼻喉科医生试图通过使用抗生素来降低发病率。所采用的治疗方案差异很大，一些人选择术后全程口服抗生素，而另一些人则倾向于预防性剂量。这项在肯尼亚肯雅塔国家医院进行的随机临床试验旨在比较单次静脉注射阿莫西林克拉维酸钾与全程口服给药在预防腺样体扁桃体切除术后发病方面的疗效。
126名计划接受腺样体扁桃体切除术的12岁以下儿童被随机分为两组。63名在诱导期接受单次静脉注射安灭菌（阿莫西林克拉维酸钾），其余一半在术后接受为期五天的相同药物口服治疗。所有患者术后均接受口服必理通（对乙酰氨基酚）。对两组患者术后七天内的疼痛、发热和饮食耐受情况进行分析和比较。
两组在术后疼痛、发热和饮食耐受方面无统计学显著差异。所有P值均>0.2。术后疼痛在术后第一天最高，随后逐渐降低，在术后第七天降至最低水平。随着疼痛减轻，患者能够耐受更固体的食物，除6人外，所有人都能耐受正常饮食。4名患者在术后第一天出现发热，但第二天未继续发热。1名患者在术后第四天和第七天发热，因胸部感染入住儿科病房。所有有发热史的患者都在术后口服阿莫西林克拉维酸钾组。
发现在诱导期静脉注射单次剂量的阿莫西林克拉维酸钾在预防腺样体扁桃体切除术后发病方面与术后全程口服给药同样有效。预防性剂量比全程口服更受青睐，因为它更便宜，确保了依从性，并且无需冷藏口服混悬液，因为在我们这样的低经济国家并非所有人都能获得冷藏条件。
ClinicalTrials.gov：NCT01267942。
