Role of antibiotics in the pre and post tonsillectomy period in reducing the morbidity associated with tonsillectomy

The aim of the study is to see the role of pre and post operative antibiotic used in the cases for which tonsillectomy was planned as a primary surgical procedure with or without adenoidectomy, for effects on peroperative blood loss, ease of surgery, postoperative fever and pain, incidence of secondary heamorrhage and return to activities of daily living [ADL]. Department of ENT and Head and Neck Surgery, Abbasi Shaheed hospital, Karachi, from June 2006 - December 2006. Prospective, double blind study. The cases which were selected for tonsillectomy were included in this study. Their full informed and written consent was obtained prior to their inclusion in the study. Two groups were made each consisting of 50 patients. In group I [intervention group] preoperatively antibiotic was used for a period of 3 days and continued for another 5 days postoperatively. The antibiotic used was Amoxicillin-Clavulanic acid according to the weight of the patients [50mg/kg/day]. In the group II [control group] no preoperative or postoperative antibiotic was used. Analgesia was given on the need and demand basis in both the groups. Pain for adult was categorized by using a pain rating scale by the British Pain Society and pediatric age group the modified Toddlers Preschooler Postoperative Pain Scale [mTPPPS]' was used. The questionnaires were given on daily basis to them for 5 days postoperatively, results recorded and then compared. Both of these groups were not aware of each other. The parameters monitored were amount of peroperative blood loss, ease of surgery, whether or not the patients had postoperative fever, secondary heamorrhage rate, pain status and return to activities of daily living. The method for tonsillectomy used was dissection method [cold steel dissection method with ties for hemostasis]. There was a significant reduction in the amount of peroperative blood loss and early return to daily activities in group land also there was an ease of surgery because of less friability of tissue and less infection and bleeding as compared to group II where the patients had a significant amount of bleeding peroperatively and delayed return to activities of daily living with a bit difficulty experienced in dissection. The incidence of post tonsillectomy [secondary] heamorrhage was not found to be of significance suggesting that there might be some other factors that may lead to this complication despite the fact that antibiotics was used in group I in comparison to group II. The level of pain experienced post operatively was not affected in either group suggesting that antibiotics do not help in decreasing or alleviating it, Fever occurred in 3 in group I while 6 had fever in group II. Seeing the results of this study we would recommend the use of pre and post operative antibiotics for the tonsillectomy patients

Micropathogens in chronic suppurative otitis media an experience of 208 pus cultures at Abbasi Shaheed Hospital

To determine the causative pathogens of chronic suppurative otitis media and their antimicrobial sensitivity. Prospective analytic study. Two hundreds patients were enrolled for the study attending the ENT out patient department of Karachi Medical and Dental College and Abbasi Shaheed Hospital. Majority of the patients were children and young adult, with male predilection. 208 Pus cultures were taken from the ears of the 175 selected patients and Gram staining and antibiotic sensitivity was done on all of them. Staphlococcus aureus and Pseudomonas aeruginosa were responsible for most of infections in this study about 68%. Proteus spp., Klebsiella spp. and E.coli were also found in the cultures but in very low figure. Quinolones and aminoglycosides were found extremely effective against the two major pathogens, i.e., Staph.aureus and Pseudomonas aeruginosa with sensitivity index of 91% and 98% respectively. Macrolides and cephalosporins were also highly effective with 80-88% sensitivity whereas both Staph.aureue and Pseudomonas were quite resistant to Ampicillin and Amoxicillin. Chronic suppurative otitis media is primarily the disease of children and young adults, and incidence in adult and old population being very less. Staphylococcus aureus and Pseudomonas aeruginosa are most frequent causative organism and extremely sensitive to quinolones and aminoglycosides