Limited role for antibiotics post-tonsillectomy

Clinical question: 
How effective are antibiotics in reducing post-tonsillectomy morbidity?
Bottom line: 
Antibiotics do not reduce pain, bleeding, the need for painkillers or the time taken to resume normal diet and activities following tonsillectomy in adults or children.┬╣ They do however appear to reduce fever, but this relatively minor benefit is more likely due to weaknesses in the studies themselves rather than any direct antibiotic effect.
Caveat: 
The risk of adverse effects such as skin rashes and diarrhoea are slightly higher in patients who are prescribed antibiotics.
Context: 
Tonsillectomy is a commonly performed operation in children and adults. In the UK only 12% of ENT specialists routinely prescribe antibiotics┬╣, compared to 79% in the USA.┬▓ Following the operation, nearly all patients experience significant pain, need regular painkillers, and are unable to resume normal diet and activities for a few hours to several days. 1. Dhiwikar M et al. Journal of Laryngology and Otology 2005 ;119 :614-619. 2. Krishna P et al. International Journal of Paediatric Otorhinolaryngology 2004 ;68 :779-784.
Review CD#: 
CD005607
PEARLS No: 
74
Date: 
May, 2008
Authored by: 
Brian R McAvoy