[Preventive antibiotic administration in complicated rhinosurgical interventions--a double-blind study].

Revision rhinoplasty was performed in 100 patients. In most cases a complete rhinoplasty with septal reconstruction, osteotomies, wedge resection and free transplants had to be done. Intranasal swabs for bacterial culture were taken pre- and postoperatively. 48 patients received three mega units of propicillin transorally for 12 days, 52 patients received a placebo. White blood count, erythrocyte sedimentation rate, and temperature were taken to indicate inflammation of the nasal region. Turbid nasal secretion, reddening and swelling of the nasal linings, and bleeding of the noninjured nasal mucosa were taken as clinical signs of infection. Preoperatively staphylococcus epidermidis was cultured in 69% from the nasal cavities, staphylococcus aureus in 42%, streptococci in 24%, diphtheroids in 22% etc. (see Table 1). Serious infections developed in six patients (five of them without antibiotics), more localized infections in twelve patients (nine of them without antibiotics). Some of the infections developed after removal of the nasal packing. In five patients with serious infections either streptococcus viridans or streptococcus pneumoniae could be cultured preoperatively. In three of five cases the streptococci were propicillin-sensitive. Clinical signs and laboratory parameters were not helpful in identifying patients with infections. We conclude that patients undergoing revision rhinosurgery should be followed carefully for at least two weeks. Postoperative administration of propicillin appears to be able to prevent serious nasal infections especially if free transplants are used.