A Systematic Review of the Prophylactic Antibiotic Use in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Lesions

Background The benefit of prophylactic antibiotic use in endoscopic endonasal transsphenoidal surgery for pituitary lesions is controversial. Many surgeons administer antibiotics perioperatively not based on clear guidelines but “to be safe.” There are various prophylactic antimicrobial regimens used in EETS without a demonstrated proof of effectiveness.

Objectives To determine if the antibiotic prophylaxis use reduces the risk of infection (e.g., meningitis, sinusitis) within 30 days after the surgery, in adult patients with pituitary lesions undergoing EETS.

Data Sources Ovid Databases, Scopus, PubMed, and Cochrane Library.

Methods A systematic review was performed to assess the efficacy of perioperative antibiotic use to prevent infectious complications in patients undergoing EETS. Inclusion criteria: randomized controlled trials including two or more groups comparing antibiotic–placebo or antibiotic–antibiotic use perioperatively for EETS, systematic reviews with/without meta-analysis, observational studies, and case series of prophylactic antibiotic perioperative use for EETS. End points: rates of meningitis and sinusitis as infectious complications after EETS.

Results A total of 280 articles were identified by the initial search. Four studies met the inclusion criteria: three retrospective descriptive cohort studies and one prospective case series study. All study participants received different antibiotic regimens perioperatively. The quality of studies did not permit performance of a meta-analysis.

Conclusion The need to use antibiotic(s) perioperatively is not clear in patients with pituitary lesions undergoing EETS. Our systematic review identified a limited number of published studies, all observational. Randomized control trials are needed to evaluate the efficacy of prophylactic antibiotic use in patients with pituitary lesions undergoing EETS.