Abstract

Objectives: The aim of this study is to evaluate the antibiotic prophylaxis practices of otorhinolaryngologists in Türkiye in different surgical operations and to assess the correlation between these approaches and the type of institution, title, professional experience, and beliefs about prophylaxis.

Patients and Methods: This study was designed as a cross-sectional, questionnaire-based, and observational study between July 2025 and December 2025. Data were collected using a questionnaire administered via Google Forms. The questionnaire consisted of 29 questions inquiring about demographic information, preferences for prophylaxis application in various surgical procedures, antibiotic selection, duration of use, and institutional protocols. Categorical data were presented as frequencies and percentages, and intergroup comparisons were made using the Fisher-Freeman-Halton test.

Results: A total of 129 otorhinolaryngologists participated in the study. 40.3% of the participants worked in training and research hospitals, and 27.1% worked in university hospitals. Cefazolin was the most frequently preferred antibiotic during the preoperative (61.3%) and intraoperative (68.6%) periods, while amoxicillin-clavulanate was the most frequently preferred antibiotic in the postoperative period (37.5%). Postoperative antibiotic use was frequently prolonged, with 53.7% stating that they continued prophylaxis for 6-7 days. A significant difference was observed between preoperative (p = 0.008) and postoperative (p = 0.003) antibiotic preferences according to institution. Differences according to title (p = 0.003) and professional experience (p = 0.002) were only found in the preoperative period. There was no significant relationship between the presence of a written prophylaxis protocol and antibiotic preferences.

Conclusion: In Türkiye, antibiotic prophylaxis practices in otorhinolaryngology can vary depending on the type of disease, institutional characteristics, and physician experience. The frequent and prolonged use of postoperative antibiotics suggests a significant discrepancy between current guideline recommendations and clinical practices.

Introduction

Surgical site infections are one of the most common healthcare-associated complications worldwide and are associated with substantial increases in morbidity, mortality, length of hospital stay, and healthcare costs.[1] Surgical antibiotic prophylaxis is defined as the administration of an appropriate antimicrobial agent before contamination occurs in tissues and body fluids that are initially sterile.[2] Its primary objective is to eliminate transient microorganisms that may colonize the surgical field during the procedure and to suppress the proliferation of bacteria belonging to the resident flora, thereby preventing the development of surgical site infections.[3] Antibiotic prophylaxis is particularly recommended for procedures associated with a high risk of infection or for operations in which postoperative infections may lead to serious morbidity or mortality, even when the baseline risk of infection is low. Surgical wound classification is one of the principal factors guiding antibiotic prophylaxis decisions. Surgical wounds are categorized into four main groups: clean, clean-contaminated, contaminated, and dirty wounds.[4] This classification serves as a practical guide for estimating the risk of surgical site infection and determining the most appropriate prophylactic strategy.

Elective otorhinolaryngologic procedures are predominantly classified as either clean or clean-contaminated surgeries. Procedures such as thyroidectomy, parotidectomy, and neck dissection are considered clean surgeries. Clean-contaminated procedures encompass a broad spectrum of operations, ranging from minor interventions such as adenoidectomy, tonsillectomy, and septoplasty to extensive resections and reconstructive surgeries performed for head and neck malignancies. This heterogeneity makes it challenging to standardize approaches to antibiotic prophylaxis.[5] Nevertheless, clinical decision-making is influenced not only by guideline recommendations but also by institutional culture, medicolegal concerns, clinical experience, and individual beliefs.[6]

Data evaluating antibiotic prophylaxis practices in otorhinolaryngologic surgery in Türkiye across a broad range of surgical procedures and healthcare settings remain limited. Unlike previous survey-based studies that generally focused on a limited number of procedures or a specific subspecialty, the present study simultaneously evaluated prophylaxis timing, antibiotic agent preference, postoperative duration, institution type, professional title, clinical experience, beliefs regarding prophylaxis, and the availability of written institutional protocols across a broad spectrum of otorhinolaryngologic procedures. Therefore, this study aimed to provide a comprehensive overview of current antibiotic prophylaxis practices among actively practicing otorhinolaryngologists in Türkiye and to examine how these practices varied according to physician-and institution-related characteristics.

Material and Methods

This cross-sectional, observational, survey-based study was conducted at Health Sciences University, Gaziosmanpaşa Training and Research Hospital, Department of Otolaryngology, between July 2025 and December 2025. The study protocol was approved by the Gaziosmanpaşa Training and Research Hospital Ethics Committee (Date: 30.04.2025, No: 56). The study was conducted in accordance with the principles of the Declaration of Helsinki. The study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement for cross-sectional studies. Participants were eligible for inclusion if they were actively practicing otorhinolaryngologists in Türkiye and voluntarily agreed to participate in the study. Duplicate responses and responses from physicians outside the field of otorhinolaryngology were excluded. Participants proceeded to the survey after reading the informed consent information provided on the first page. Completion of the questionnaire was considered to indicate informed consent.

A priori power analysis was performed to determine the required sample size for the study. The analysis indicated that a minimum of 85 participants was required to achieve 80% statistical power (effect size = 0.36, α = 0.05, 1-β = 0.80, df = 3).

Questionnaires containing sufficient information for the primary study variables were included in the analysis. Since some questions were conditional or were not answered by all participants, the number of valid responses varied across individual survey items.

No restrictions were applied regarding the type of institution, academic title, or years of professional experience. The survey link was distributed by the investigators through professional communication groups and individual communication channels. Participants were asked to share the survey with their colleagues, thereby utilizing a distribution strategy similar to snowball sampling.

Data were collected using a structured questionnaire developed by the investigators and administered through the Google Forms (Google LLC, Mountain View, CA, USA) platform. The survey was conducted anonymously, and no personally identifiable information was collected in order to protect participant confidentiality and minimize information bias. Nevertheless, as participation was voluntary and the survey was distributed using a strategy similar to snowball sampling, selection bias and response bias cannot be completely excluded. Furthermore, as the data were based on self-reported responses, discrepancies may exist between reported practices and actual clinical practice.

Participants were asked about their institutional affiliation (university hospital, training and research hospital, state hospital, private hospital, or private practice), professional title (resident, specialist, assistant professor, associate professor, or professor), and years of clinical experience in otorhinolaryngology (0-5, 6-10, 11-15, 16-20, and > 20 years).

Participants were asked to indicate their preferences regarding antibiotic prophylaxis for the following procedures: adenoidectomy, tonsillectomy (pediatric and adult), adenotonsillectomy, ventilation tube insertion, septoplasty (open and closed techniques), septorhinoplasty, endoscopic sinus surgery, tympanoplasty, simple mastoidectomy, radical mastoidectomy, parotidectomy, thyroidectomy, uncomplicated neck mass excision, primary neck dissection, head and neck cancer surgery performed in conjunction with neck dissection, and complex oncologic procedures requiring locoregional or free-flap reconstruction.

For each surgical procedure, participants could select one or more of the following options: no antibiotic prophylaxis, preoperative prophylaxis, intraoperative prophylaxis, and postoperative prophylaxis. Multiple selections were allowed to capture variations in prophylaxis timing and to better reflect real-world clinical practice.

Participants who reported using antibiotic prophylaxis were asked to indicate their preferred antibiotic agents for the preoperative, intraoperative, and postoperative periods. Information was also collected regarding the usual duration of postoperative antibiotic prophylaxis (24 h, 2-5 days, 6-7 days, 8-10 days, or > 10 days). Percentages for these variables were calculated using the number of responses available for the corresponding item as the denominator, and item-specific denominators are reported in the tables.

Participants were also asked whether a written protocol for antibiotic prophylaxis was available at their institution. Additionally, their beliefs regarding the effectiveness of antibiotic prophylaxis in reducing postoperative infection rates and their corresponding clinical practices were assessed.

Statistical analysis

Comparisons between categorical variables were performed using the Fisher-Freeman-Halton test. Descriptive statistics were presented as frequencies and percentages. All statistical analyses were conducted using IBM SPSS Statistics version 29.0.2 software (IBM Corp., Armonk, NY, USA), and a two-sided p-value <0.05 was considered statistically significant.

Results

Participant characteristics and general approach

Since the survey link was distributed through professional communication groups and shared among colleagues using a snowball sampling-like strategy, the total number of physicians who received the survey invitation could not be determined. Therefore, a response rate could not be calculated. After the exclusion of ineligible or duplicate responses, 129 participants were included in the final analysis. The number of valid responses varied across individual survey items, as some questions were conditional or were not answered by all participants.

Participants were primarily affiliated with training and research hospitals (40.3%) and university hospitals (27.1%). Specialists constituted 44.2% of the sample, and professional experience was evenly distributed across seniority groups. Overall, 46.1% of participants stated that no written antibiotic prophylaxis protocol was available at their institution, and 32.0% were unsure.

Regarding antibiotic preferences, cefazolin was the most frequently selected agent in both the preoperative (61.3%) and intraoperative (68.6%) periods, whereas amoxicillin–clavulanate was the most frequently selected agent in the postoperative period (37.5%). Regarding the duration of postoperative antibiotic use, 53.7% of participants reported prescribing antibiotics for 6-7 days.

Regarding beliefs about the effectiveness of antibiotic prophylaxis, 64.3% of participants reported believing that prophylaxis reduced postoperative infection rates and routinely used it in practice. Conversely, 31.0% reported using antibiotic prophylaxis despite believing that it did not reduce infection rates. Demographic and clinical characteristics of the participants are presented in Table 1.

Table 1. Demographic and clinical characteristics of the participants

Antibiotic prophylaxis practices according to surgical procedure

The rates of antibiotic prophylaxis use varied across surgical procedures. Among procedures with lower reported prophylaxis use, 57.7% of participants reported administering prophylaxis during at least one perioperative period for adenoidectomy, while 52.5% reported doing so for ventilation tube insertion. In tonsillectomy, the corresponding rates were 67.5% for pediatric patients and 72.4% for adult patients. Higher rates of prophylaxis use were reported for septorhinoplasty, endoscopic sinus surgery, tympanoplasty, and mastoidectomy. The highest rates were observed in head and neck oncologic procedures, with prophylaxis being reported during at least one perioperative period by 91.7% of participants for primary neck dissection, 94.4% for oral cavity, oropharyngeal, and laryngeal surgery, and 91.6% for procedures requiring flap reconstruction. With regard to timing, postoperative administration was the most commonly reported approach across many procedure types. Antibiotic prophylaxis rates according to surgical procedure are presented in Table 2.

Table 2. Distribution of antibiotic prophylaxis practices according to surgical procedure

Distribution of antibiotic preferences according to institution type, professional title, clinical experience, and availability of a written protocol

Preoperative (p = 0.008) and postoperative (p = 0.003) antibiotic preferences differed signif icantly according to institution type, whereas no significant difference was observed for intraoperative antibiotic preferences (p = 0.261). Although cefazolin was the most commonly preferred antibiotic in the preoperative period overall, its use was less frequent in university hospitals (46.9%) and more frequent in state hospitals (71.4%), private hospitals (83.3%), and private practices (81.8%). Alternative agents, including ceftriaxone and amoxicillin-clavulanate, were preferred more frequently in university hospitals, whereas ampicillin-sulbactam use was more common in training and research hospitals. In the postoperative period, amoxicillin-clavulanate was more frequently preferred in university hospitals and training and research hospitals, whereas cefazolin use was more common in state and private hospitals, as shown in Table 3.

Table 3. Comparison of preferred preoperative, intraoperative, and postoperative antibiotics according to institution type

According to professional title, a significant difference was observed only in preoperative antibiotic preferences (p = 0.003). Antibiotic selection was more heterogeneous among resident physicians, whereas cefazolin preference was more pronounced among specialists and participants holding more senior academic positions. No significant differences according to professional title were observed for intraoperative or postoperative antibiotic preferences (p = 0.494 and p = 0.181, respectively), as shown in Table 4.

Table 4. Comparison of preferred preoperative, intraoperative, and postoperative antibiotics according to professional title

Similarly, a significant difference among professional experience groups was observed only for preoperative antibiotic preferences (p = 0.002). No significant differences according to professional experience were observed for intraoperative or postoperative antibiotic preferences (p = 0.276 and p = 0.142, respectively), as shown in Table 5.

Table 5. Comparison of preferred preoperative, intraoperative, and postoperative antibiotics according to professional experience

No significant association was observed between the availability of a written antibiotic prophylaxis protocol and antibiotic preferences in any perioperative period (preoperative p = 0.513, intraoperative p = 0.568, and postoperative p = 0.555). Similarly, no significant differences were found in the duration of postoperative antibiotic use according to institution type, professional title, clinical experience, or the availability of a written antibiotic prophylaxis protocol (all p > 0.05), as shown in Tables 6 and 7.

Table 6. Comparison of preferred preoperative, intraoperative, and postoperative antibiotics according to availability of a written antibiotic prophylaxis protocol

Table 7. Comparison of postoperative antibiotic prophylaxis duration according to institution type, professional title, professional experience, and availability of a written protocol

Discussion

The incidence of surgical site infections following clean head and neck procedures is generally below 5% and has been reported to be as low as 0.56% in certain series.[7,8] Due to this low incidence, no randomized controlled trials have demonstrated a benefit of prophylactic antibiotic use, and available retrospective cohort studies have likewise failed to demonstrate a significant reduction in infection rates.[7-9] Accordingly, routine antibiotic prophylaxis is not recommended for clean surgical procedures.[4,10,11] Despite these recommendations, 83.0% of participants in our study reported using antibiotic prophylaxis during at least one perioperative period for thyroidectomy, 85.6% for parotidectomy, and 75.2% for uncomplicated neck mass excision. The corresponding rate was 91.7% for primary neck dissection. Postoperative prophylaxis rates exceeded 50% across all evaluated head and neck procedures. These findings suggest that, in routine clinical practice, antibiotic prophylaxis is used more broadly and for longer durations than recommended by current guidelines, even in clean surgical procedures.

The risk of surgical site infection is substantially higher in clean-contaminated head and neck procedures (24-87%).[12,13] In this setting, numerous randomized controlled trials and meta-analyses have demonstrated that perioperative antibiotic prophylaxis reduces postoperative infectious complications.[14-16] However, clean-contaminated procedures in otorhinolaryngology encompass a highly heterogeneous group of operations. Consequently, no single prophylactic strategy is applicable to all procedures, and recommendations vary according to the type and complexity of surgery. A systematic review of international guidelines has similarly emphasized that recommendations for perioperative antibiotic prophylaxis in head and neck surgery should be tailored to wound classification and procedural characteristics rather than applied uniformly across all operations.[17] More recent evidence also suggests that cefazolin, ampicillinsulbactam, and amoxicillin-clavulanate are among the most effective agents for clean-contaminated head and neck surgery, whereas extending prophylaxis beyond 24-48 h does not appear to provide additional protection against surgical site infection.[18]

Although adenoidectomy, tonsillectomy, and adenotonsillectomy are categorized as clean-contaminated procedures, current guidelines do not recommend routine antibiotic prophylaxis for these operations.[4,19,20] Nevertheless, prophylaxis administration during at least one perioperative period was reported for adenoidectomy (57.7%), pediatric tonsillectomy (67.5%), adult tonsillectomy (72.4%), and adenotonsillectomy (68.9%). These findings indicate that antibiotic prophylaxis continues to be widely used in these procedures despite current guideline recommendations against its routine use.

Septoplasty is generally considered a cleancontaminated procedure for which routine antibiotic prophylaxis is not recommended.[4,11,20] Furthermore, the use of nasal packing in uncomplicated septoplasty has not been associated with a significant increase in postoperative infection rates.[21,22] However, infection risk may differ in more complex procedures, including revision septorhinoplasty, graft-based nasal surgery, and septal defect repair.[23] A recent systematic review and meta-analysis found no substantial evidence that prophylactic antibiotics reduce postoperative infection rates in septoplasty, rhinoplasty, or septorhinoplasty, although the available studies were heterogeneous and included procedures of varying complexity.[24] In our study, antibiotic prophylaxis during at least one perioperative period was reported for closed septoplasty (77.4%), open septoplasty (84.6%), and septorhinoplasty (87.8%). These findings indicate that prophylaxis remains commonly used across nasal procedures despite the limited evidence supporting its routine use, particularly in uncomplicated cases.

Evidence regarding antibiotic prophylaxis in endoscopic sinus surgery varies according to the surgical indication and clinical context. Recent evidence does not support the routine use of postoperative antibiotics following uncomplicated endoscopic sinus surgery for chronic rhinosinusitis. A systematic review found no level 1 evidence that postoperative antibiotics improve patient-reported or endoscopic outcomes after sinus surgery, although the available evidence regarding postoperative infection remains limited and heterogeneous.[25] Similarly, a randomized, double-blind, placebo-controlled trial reported no significant advantage of amoxicillinclavulanate over placebo in terms of sinonasal quality of life, endoscopic findings, or postoperative infection rates, while diarrhea was more frequent among patients receiving antibiotics.[26] In contrast, procedures performed for malignancy, active infection, or extensive reconstruction may involve different contamination risks and should be evaluated separately. In our study, prophylaxis during at least one perioperative period was reported by 81.7% of respondents for endoscopic sinus surgery, and 58.3% reported postoperative antibiotic use. These findings indicate that postoperative antibiotic administration remains common despite the limited evidence supporting its routine use after uncomplicated surgery for chronic rhinosinusitis.

Antibiotic prophylaxis is recommended for clean-contaminated head and neck oncologic procedures and surgeries requiring f lap reconstruction.[4,10,11,20] However, the optimal antibiotic agent and duration, particularly in complex procedures involving free-f lap reconstruction, remain subjects of debate. Current evidence generally supports perioperative prophylaxis for 24-48 h, whereas continuation beyond 48 h has not been shown to provide additional protection against surgical site infection and may increase antibiotic-related adverse effects.[18,27] Consistent with the indication for prophylaxis in these procedures, prophylaxis during at least one perioperative period was reported by 94.4% of respondents for clean-contaminated oncologic surgery and 91.6% for surgeries involving locoregional or free-flap reconstruction.

Regarding otologic surgeries, antibiotic prophylaxis is not recommended for ventilation tube insertion or tympanoplasty, whereas it is recommended for mastoidectomy performed for chronic otitis media.[11,20] Nevertheless, in our study, prophylaxis during at least one perioperative period was reported for ventilation tube insertion (52.5%) and tympanoplasty (80.2%). In contrast, prophylaxis rates were 85.7% for simple mastoidectomy and 87.3% for radical mastoidectomy, suggesting that antibiotic prophylaxis is more consistently used in more complex otologic procedures.

International guidelines for surgical antimicrobial prophylaxis recommend cefazolin as the first-line agent for clean-contaminated procedures due to its favorable tissue penetration, narrow antimicrobial spectrum, and reliable pharmacokinetic profile.[1,4,28] In our study, cefazolin was the most frequently selected antibiotic in both the preoperative (61.3%) and intraoperative (68.6%) periods. This finding is largely consistent with current international recommendations for surgical prophylaxis. In contrast, postoperative antibiotic preferences were more heterogeneous, with amoxicillin-clavulanate being the most frequently selected agent (37.5%). Broad-spectrum antibiotics were commonly preferred during the postoperative period. Current evidence recommends administration of prophylactic antibiotics within 60 minutes before surgical incision, additional intraoperative dosing when procedures are prolonged, and discontinuation within 24 h for most procedures, although prophylaxis may be continued for up to 48 h in selected complex clean-contaminated head and neck procedures.[4,11,12,18,20] Prolonged administration does not reduce surgical site infections and may instead contribute to antimicrobial resistance, adverse effects, and increased healthcare costs.[29] In our study, only 8.9% of participants who reported using postoperative prophylaxis limited its duration to 24 h. More than 90% reported continuing prophylaxis beyond 24 h, most commonly for 6-7 days (53.7%). The tendency toward prolonged prophylaxis and the frequent use of broad-spectrum antibiotics in the postoperative period suggest that the concepts of prophylaxis and treatment may become blurred in routine clinical practice.

In our study, antibiotic prophylaxis preferences differed significantly according to institution type, particularly in the preoperative and postoperative periods. Although cefazolin was the most frequently selected antibiotic across all institutions in the preoperative period, its use was less common in university hospitals and training and research hospitals, where alternative agents such as ceftriaxone, ampicillin-sulbactam, and amoxicillin-clavulanate were more frequently preferred. This pattern may be related to the more heterogeneous patient populations, greater procedural complexity, and diversity of clinical practices typically encountered in tertiary referral centers. However, since our survey assessed antibiotic prophylaxis preferences in general rather than for specific surgical procedures, definitive conclusions cannot be drawn regarding the reasons underlying these differences. Indeed, current guidelines recommend cefazolin plus metronidazole, cefuroxime plus metronidazole, or ampicillin-sulbactam for certain complex procedures, including head and neck oncologic surgery.[4] In contrast, the higher rates of cefazolin use observed in state and private hospitals may reflect a more standardized approach to surgical prophylaxis. During the intraoperative period, cefazolin remained the predominant agent across all institution types. In the postoperative period, the more frequent use of amoxicillin-clavulanate in university hospitals and training and research hospitals may indicate a preference for broader-spectrum coverage against potential surgical site infections.

When institution type and professional experience were considered together, differences in antibiotic preferences were observed only during the preoperative period. Similarly, analyses according to professional title and years of experience showed that antibiotic selection was more heterogeneous among resident physicians and less experienced clinicians, whereas cefazolin preference increased with greater experience and seniority. Previous studies have suggested that younger physicians may use antibiotics more liberally due to medicolegal concerns and limited clinical experience.[30] However, the pattern observed in our study may also be related to the greater proportion of residents and less experienced physicians working in university hospitals and training and research hospitals. Indeed, preoperative antibiotic preferences were found to be more heterogeneous in these institutions. Nevertheless, no significant differences in antibiotic preferences according to professional title or experience were observed during the intraoperative or postoperative periods.

Another important finding of our study was that the reported availability of a written antibiotic prophylaxis protocol was not significantly associated with antibiotic preferences or postoperative prophylaxis duration. This finding suggests that the reported availability of a written protocol alone may not ensure standardized practice. However, the content, implementation, accessibility, and adherence to these protocols were not assessed in the present study.

Approximately one-third of participants in our study reported continuing to use antibiotic prophylaxis despite believing that it does not reduce postoperative infection rates. Furthermore, no statistically significant association was observed between beliefs regarding the effectiveness of prophylaxis and self-reported prescribing behavior. These findings suggest that decisions regarding antibiotic prophylaxis are not based solely on scientific evidence or personal beliefs. Rather, factors such as established practice patterns, institutional routines, and particularly medicolegal concerns may play an important role in shaping prescribing behavior.

One of the most noteworthy findings of our study was that rates of antibiotic prophylaxis appeared to increase in parallel with the magnitude and complexity of the surgical procedure rather than according to surgical wound classification (clean vs. clean-contaminated). International guidelines for surgical antimicrobial prophylaxis primarily base recommendations on wound classification, the risk of contamination, and the presence of implants or prosthetic materials.[1,3,4] Nevertheless, our data demonstrated that prophylaxis rates approached 90% even for clean procedures such as thyroidectomy and parotidectomy. These findings suggest that antibiotic prophylaxis practices may be more closely associated with perceived surgical risk and procedural invasiveness than with surgical wound classification alone. Similar patterns have been reported in other surgical specialties, where antibiotic use has been shown to increase in major and complex procedures regardless of guideline recommendations.[31]

In our study, the use of prophylactic antibiotics exceeded current guideline recommendations across all surgical categories. However, this discordance does not appear to be unique to Türkiye. Previous surveys conducted in the United States, Australia, and New Zealand have also reported substantial variation in perioperative antibiotic practices and frequent antibiotic use despite limited evidence of clinical benefit.[32-35] An international survey of head and neck surgeons similarly demonstrated considerable heterogeneity in surgical site infection prevention practices, including antibiotic selection and duration.[36] Therefore, the high rates of postoperative and prolonged antibiotic use observed in our study should be interpreted as part of a broader international guideline-practice gap, although the predominance of 6-7-day postoperative regimens may indicate a particularly pronounced stewardship concern in Türkiye.

Our study has certain limitations that warrant consideration. First, the study was based on self-reported responses rather than direct observation of clinical practice; therefore, discrepancies may exist between reported behaviors and actual prophylaxis practices. Second, the survey link was distributed through professional communication networks using a snowball sampling–like strategy, which may have introduced selection bias and resulted in the overrepresentation of physicians with a particular interest in antibiotic prophylaxis. Third, given that participation was voluntary, the possibility of response bias cannot be excluded. Detailed information regarding surgical case mix, institutional patient profiles, local microbiological epidemiology, and antimicrobial stewardship practices was not collected, although these factors may inf luence prophylaxis decisions. In addition, antibiotic agent preferences were assessed separately for the preoperative, intraoperative, and postoperative periods but were not collected on a procedure-specific basis in order to limit questionnaire length and respondent burden. Therefore, it was not possible to determine which agents were preferred for individual surgical procedures or to assess the appropriateness of agent selection according to procedure type and contamination risk. Furthermore, demographic parameters such as age and sex were not recorded, which precluded the evaluation of prophylaxis preferences across demographic subgroups. Finally, although several subgroup analyses were performed, the study was not designed to evaluate independent predictors of antibiotic prophylaxis behavior through multivariable modeling. Consequently, the potential interrelationships and confounding effects among institution type, academic title, and professional experience could not be fully disentangled.

Despite these limitations, the inclusion of physicians from a wide range of healthcare settings and professional experience levels represents an important strength of the study, providing a contemporary and comprehensive overview of antibiotic prophylaxis practices in otorhinolaryngology across Türkiye. The participation of clinicians from different regions of the country and diverse healthcare institutions enhances the national relevance of the findings. Nevertheless, since a non-probability sampling strategy was employed, caution is warranted when generalizing the results to the entire population of otorhinolaryngologists practicing in Türkiye.

In conclusion, our findings indicate that self-reported antibiotic prophylaxis practices in otorhinolaryngology varied more closely with the invasiveness and complexity of surgical procedures than with surgical wound classification. Preoperative antibiotic selection differed according to professional seniority and institution type, whereas the reported availability of a written protocol was not significantly associated with antibiotic preferences or postoperative prophylaxis duration. The observed discordance between clinical beliefs and reported practice further suggests that factors beyond scientific evidence may contribute to decisions regarding antibiotic prophylaxis. However, these findings should be interpreted in light of the snowball sampling strategy, the unknown response rate, and the reliance on self-reported practices rather than direct observation of actual prescribing behavior. These findings suggest that the availability of clinical guidelines alone may be insufficient to achieve meaningful standardization of practice. Multidisciplinary antimicrobial stewardship programs, regular audit and feedback mechanisms, and targeted educational interventions may be necessary to improve adherence to evidence-based recommendations. In particular, reducing unnecessary or prolonged prophylaxis in clean and clean-contaminated procedures is critical for combating antimicrobial resistance.

Citation: Tetik F. Antibiotic prophylaxis practices in otorhinolaryngology: A National Cross-Sectional Survey from Türkiye. Praxis Otorhinolaryngol 2026;14(3):135-150. https://doi.org/10.5606/kbbu.2026.44.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure
The author declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the author. The author further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

The author declared no conflicts of interest with respect to the authorship and/or publication of this article.

The author received no financial support for the research and/or authorship of this article.

References

1. Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: An evidence-based global perspective. Lancet Infect Dis 2016;16:e276-87. doi: 10.1016/S1473-3099(16)30398-X.
2. Fennessy BG, Harney M, O’Sullivan MJ, Timon C. Antimicrobial prophylaxis in otorhinolaryngology/head and neck surgery. Clin Otolaryngol 2007;32:204-7. doi: 10.1111/j.1365-2273.2007.01440.x.
3. ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery. American Society of Health-System Pharmacists. Am J Health Syst Pharm 1999;56:1839-88. doi: 10.1093/ajhp/56.18.1839.
4. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70:195-283. doi: 10.2146/ajhp120568.
5. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250- 78. doi: 10.1086/501620.
6. Bardia A, Melnick ER, McCall T, Zhao X, Lin HM, Fisher C, et al. Individual and system-level factors contributing to guideline nonadherent surgical antibiotic prophylaxis at a tertiary healthcare system: A qualitative analysis. Anesthesiology 2025;142:489-99. doi: 10.1097/ ALN.0000000000005302.
7. Avenia N, Sanguinetti A, Cirocchi R, Docimo G, Ragusa M, Ruggiero R, et al. Antibiotic prophylaxis in thyroid surgery: A preliminary multicentric Italian experience. Ann Surg Innov Res 2009;3:10. doi: 10.1186/1750-1164-3- 10.
8. Johnson JT, Wagner RL. Infection following uncontaminated head and neck surgery. Arch Otolaryngol Head Neck Surg 1987;113:368-9. doi: 10.1001/ archotol.1987.01860040030010.
9. Man LX, Beswick DM, Johnson JT. Antibiotic prophylaxis in uncontaminated neck dissection. Laryngoscope 2011;121:1473-7. doi: 10.1002/lary.21815.
10. Patel PN, Jayawardena ADL, Walden RL, Penn EB, Francis DO. Evidence-based use of perioperative antibiotics in otolaryngology. Otolaryngol Head Neck Surg 2018;158:783-800. doi: 10.1177/0194599817753610.
11. Obeso S, Rodrigo JP, Sánchez R, López F, Díaz JP, Suárez C. Antibiotic prophylaxis in otolaryngologic surgery. Acta Otorrinolaringol Esp 2010;61:54-68. doi: 10.1016/j. otorri.2008.12.006.
12. Simo R, French G. The use of prophylactic antibiotics in head and neck oncological surgery. Curr Opin Otolaryngol Head Neck Surg 2006;14:55-61. doi: 10.1097/01. moo.0000193183.30687.d5.
13. Weber RS, Callender DL. Antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery. Ann Otol Rhinol Laryngol Suppl 1992;155:16-20. doi: 10.1177/00034894921010s104.
14. Saginur R, Odell PF, Poliquin JF. Antibiotic prophylaxis in head and neck cancer surgery. J Otolaryngol 1988;17:78-80.
15. Velanovich V. A meta-analysis of prophylactic antibiotics in head and neck surgery. Plast Reconstr Surg 1991;87:429-34.
16. Chiesa-Estomba CM, Ninchritz E, González-García JA, Larruscain-Sarasola E, Sistiaga-Suarez JA, AltunaMariezcurrena X. Antibiotic prophylaxis in clean head and neck surgery: An observational retrospective singlecentre study. Ear Nose Throat J. 2019;98:362-5. doi: 10.1177/0145561319853520.
17. Chiesa-Estomba CM, Lechien JR, Fakhry N, Melkane A, Calvo-Henriquez C, de Siati D, et al. Systematic review of international guidelines for perioperative antibiotic prophylaxis in Head & Neck Surgery. A YO-IFOS Head & Neck Study Group Position Paper. Head Neck 2019;41:3434-56. doi: 10.1002/hed.25856.
18. Vander Poorten V, Uyttebroek S, Robbins KT, Rodrigo JP, de Bree R, Laenen A, et al. Perioperative antibiotics in clean-contaminated head and neck surgery: A systematic review and meta-analysis. Adv Ther 2020;37:1360-80. doi: 10.1007/s12325-020-01269-2.
19. Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, et al. Clinical practice guideline: Tonsillectomy in children (Update). Otolaryngol Head Neck Surg 2019;160:S1-42. doi: 10.1177/0194599818801757.
20. Ottoline AC, Tomita S, Marques Mda P, Felix F, Ferraiolo PN, Laurindo RS. Antibiotic prophylaxis in otolaryngologic surgery. Int Arch Otorhinolaryngol 2013;17:85-91. doi: 10.7162/S1809-97772013000100015.
21. Manzini M, Cuda D, Caroggio A. Nasal packing and antibiotic prophylaxis in septoplasty: A controlled study. Acta Otorhinolaryngol Ital 1998;18:88-95.
22. Persaud RA, Awad Z, Trinidade A, Kalan A. Use of systemic prophylactic antibiotics with anterior nasal packing in England, UK. Clin Otolaryngol 2007;32:399. doi: 10.1111/j.1749-4486.2007.01457.x.
23. Andrews PJ, East CA, Jayaraj SM, Badia L, Panagamuwa C, Harding L. Prophylactic vs postoperative antibiotic use in complex septorhinoplasty surgery: A prospective, randomized, single-blind trial comparing efficacy. Arch Facial Plast Surg 2006;8:84-7. doi: 10.1001/ archfaci.8.2.84.
24. Benites C, Awan MU, Patel H, Pandit S, Shifchik A, Harmon S, et al. An examination of antibiotic administration in septorhinoplasty: A systematic review and meta-analysis. Am J Otolaryngol 2024;45:104333. doi: 10.1016/j.amjoto.2024.104333.
25. Swords CE, Wong JJ, Stevens KN, Psaltis AJ, Wormald PJ, Tan NC. The use of postoperative antibiotics following endoscopic sinus surgery for chronic rhinosinusitis: A systematic review and meta-analysis. Am J Rhinol Allergy 2021;35:700-12. doi: 10.1177/1945892421989142.
26. Lehmann AE, Raquib AR, Siddiqi SH, Meier J, Durand ML, Gray ST, et al. Prophylactic antibiotics after endoscopic sinus surgery for chronic rhinosinusitis: A randomized, double-blind, placebo-controlled noninferiority clinical trial. Int Forum Allergy Rhinol 2021;11:1047-55. doi: 10.1002/alr.22756.
27. Goormans F, van Mierlo A, Spriet I, et al. Antibiotic prophylaxis in patients undergoing oncologic head and neck surgery with free flap reconstruction: Still a matter of debate. Antibiotics (Basel) 2025;14:1160. doi: 10.3390/ antibiotics14111160.
28. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017;152:784-91. doi: 10.1001/jamasurg.2017.0904.
29. Branch-Elliman W, O’Brien W, Strymish J, Itani K, Wyatt C, Gupta K. Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events. JAMA Surg 2019;154:590-8. doi: 10.1001/ jamasurg.2019.0569.
30. Rawson TM, Charani E, Moore LS, Hernandez B, Castro-Sánchez E, Herrero P, et al. Mapping the decision pathways of acute infection management in secondary care among UK medical physicians: A qualitative study. BMC Med 2016;14:208. doi: 10.1186/s12916-016-0751-y.
31. Koçak F, Balkan İİ, Doğan Çelik A, Durdu B. Perioperatif antimikrobiyal profilaksi uygulamalarında rehberlere uyum: çok merkezli bir çalışma. Anadolu Klin Tıp Bilim Derg 2017;22:8-15. doi: 10.21673/anadoluklin.268873.
32. Torun MT. Usage of surgical antibiotic prophylaxis in routine otolaryngologic surgeries in Turkey. Int Arch Otorhinolaryngol 2022;27:e123-9. doi: 10.1055/s-0042-1745727.
33. Valdez TA, Marvin K, Bennett NJ, Lerer T, Nolder AR, Buchinsky FJ. Current trends in perioperative antibiotic use: A survey of otolaryngologists. Otolaryngol Head Neck Surg 2015;152:63-6. doi: 10.1177/0194599814554551.
34. Ahmadzada S, Wong EH, Naidoo Y. Antibiotic prescribing practices in otolaryngology head and neck surgery in Australia and New Zealand: a survey of 137 specialists. Aust J Otolaryngol 2019;2:11. doi: 10.21037/ ajo.2019.02.03.
35. Rechtweg JS, Paolini RV, Belmont MJ, Wax MK. Postoperative antibiotic use of septoplasty: A survey of practice habits of the membership of the American Rhinologic Society. Am J Rhinol 2001;15:315-20.
36. Chiesa-Estomba CM, Calvo-Henriquez C, Gonçalves N, Lechien JR, Sistiaga-Suarez JA, Mayo-Yanez M, et al. Patterns of practice regarding surgical site infection prevention in head & neck surgery: An international survey. Acta Otorrinolaringol Esp (Engl Ed) 2022;73:225-34. doi: 10.1016/j.otoeng.2021.06.004.