Table 2.
Surgical antimicrobial prophylaxis (SAP) for neonates and children undergoing dental, maxillo-facial or ear-nose-throat (ENT) surgeries.
| Clinical Scenario | Recommendation |
|---|---|
| Dental surgery | No peri-operative antibiotic prophylaxis is recommended. Oral amoxicillin or ampicillin ev (50 mg/kg for both) should be administered during the 30 min before surgery if the operation involves the manipulation of gum tissue or the periapical region of the teeth or involves the perforation of the oral mucosa and the subject has already suffered from endocarditis, has already been operated with the application of prosthetic material, has a cyanogenic congenital heart disease which has not yet fully repaired, has a congenital heart disease already repaired with the application of prosthetic material in the 6 months following surgery or has been transplanted and has developed valvulopathy. No prophylaxis is recommended in subjects with prosthetic implants. |
| Maxillo-facial fracture surgery | Pre-operative antibiotic prophylaxis with oral amoxicillin 50 mg/kg is recommended within 30 min prior to surgery when the surgery involves the mandible. Prophylaxis is not recommended in the case of maxillary or zygomatic surgery. |
| Temporo-mandibular surgery | Pre-operative antibiotic prophylaxis with cefazolin in a single dose of 30 mg/kg (maximum dose 2 g) EV is recommended in the 30 min before surgery. |
| Cleft lip or cleft palate repair | Peri-operative prophylaxis with ampicillin/sulbactam at a dose of 50 mg/kg (as ampicillin) EV is recommended to be administered within 30 min before surgery. |
| Ear surgery | Peri-operative antibiotic prophylaxis is not recommended for clean surgery, whereas it is recommended in cases of clean/contaminated or contaminated operation and for cochlear implant placement. When antibiotic prophylaxis is indicated, it is recommended to administer cefazolin as a single dose of 30 mg/kg (maximum dose 2 g) EV within 30 min before surgery. |
| Endoscopic paranasal cavity surgery and septoplasty | It is recommended to administer peri-operative antibiotic prophylaxis with cefazolin 30 mg/kg (maximum dose 2 g) EV within the 30 min before surgery. No antibiotic prophylaxis is recommended in septoplasty. |
| Clean head and neck surgery | No perioperative antibiotic prophylaxis is recommended in the case of neonatal or pediatric patients undergoing clean head and neck surgery (i.e., thyroidectomy, parathyroidectomy, salivary gland surgeries, the removal of lymphangiomas and the excision of lateral and medial neck cysts and fistulas). |
| Clean-contaminated head and neck surgery | In the case of a neonatal or pediatric patient undergoing clean-contaminated ENT surgery (i.e., oral cavity resection, laryngectomy, pharyngectomy, tracheotomy or maxillary of upper airways tumor masses), peri-operative antibiotic prophylaxis with cefazolin 30 mg/kg (maximum dose 2 g) EV administered within 30 min before surgery combined with metronidazole 15 mg/kg (max 500 mg) is recommended. |
| tonsillectomy, adenoidectomy or both | No antibiotic prophylaxis is recommended. |