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Postoperative antibiotic therapy did not significantly reduce infection risk among patients undergoing rhinoplasty, a systematic review and meta-analysis found.

With data on 589 patients in five randomized trials, the pooled risk ratio of infection for prophylactic antibiotics (given prior to, during, or after procedures) vs placebo was 0.92 (95% CI 0.35-2.43; P=0.86), reported Sam Most, MD, of Stanford University School of Medicine in California, and colleagues in .

Other data that compared postoperative antibiotics against placebo, excluding preoperative or perioperative treatment, did suggest a potential benefit, with a pooled risk ratio of 0.43 (95% CI 0.18-1.04; P=0.06), the investigators found.

Clinicians often use antibiotic prophylaxis to prevent postoperative infection following rhinoplasty, the study authors highlighted. Although common practice, "the evidence on antibiotic prophylaxis effectiveness and the superiority of particular administration regimens is controversial," Most and colleagues wrote.

A 2017 clinical practice guideline pointed out that the harm resulting from routine postoperative antibiotics might offset the benefit from reducing postoperative infections, the authors noted.

"However, no definitive recommendations were offered concerning optimal preoperative, perioperative, or postoperative antibiotic prophylaxis in rhinoplasty," the researchers continued.

The included studies involved patients 18 and older undergoing rhinoplasty. Studies were assessed without restrictions based on language or date of publication.

Interventions fell into three types of categories which were compared and included: administration of a single-dose systemic antibiotic within 1 day before the first incision, administration of a multidose systemic antibiotic treatment within 1 day leading up to the first incision and following the operation, and single or multidose systemic antibiotic therapy within 1 day following the incision.

Neither this report nor previous ones have addressed the heterogeneity in rhinoplasty procedures, which can vary in scope, incisions, length of surgery, and use of grafts or foreign materials, the investigators emphasized.

Therefore, it remains "important to be vigilant regarding infection risk, and the above recommendations are not a replacement for clinical judgment on a case-by-case basis," Most and colleagues wrote.