Perioperative antibiotic therapy in orofacial cleft surgery. What is the consensus?

Abstract

Clefts of the primary and secondary palate represent one of the commonest congenital anomaly for which surgical correction is required. The perioperative care of the patients varies widely across centers and among surgeons and range from preoperative swab of palatal clefts for microbiological studies to prophylactic and or therapeutic antibiotic care. These practices have economic implications especially in the Low and Middle Income Countries (LMIC) where the cost of care are borne directly by the parents. The clinical implications of indiscriminate antibiotic use may also include development of resistant strains and hypersensitivity reactions which may be life  threatening. Surgical site infections and its possible sequelae of dehiscence and fistulae is another concern for the surgeon and the patient. This review examines the microbiological pathogens, surgeon’s perspectives as well as the current evidences for the use of perioperative antibiotic therapy in orofacial cleft surgery and concludes with a need for a large multicenter randomized clinical trial to answer critical aspects of the subject.