Head and Neck TumorsHead and Neck TumorsОпухоли головы и шеи2222-14682411-4634Publishing House ABV Press52710.17650/2222-1468-2020-10-2-54-60REVIEWОБЗОРНАЯ СТАТЬЯAntibiotic prophylaxis for head and neck cancer surgeryАнтибиотикопрофилактика при хирургическом лечении опухолей головы и шеиhttps://orcid.org/0000-0002-8164-2261GuzA. O.ГузьА. О.
Russian Federation

42 Blukhera St., Chelyabinsk 454087

Челябинск 454087, ул. Блюхера, 42

https://orcid.org/0000-0001-9533-4107FatkullinD. M.ФаткуллинД. М.
Russian Federation

42 Blukhera St., Chelyabinsk 454087

Дмитрий Маратович Фаткуллин  

Челябинск 454087, ул. Блюхера, 42

gaba-9@yandex.ruhttps://orcid.org/0000-0002-1831-3748GarevA. V.ГаревА. В.
Russian Federation

42 Blukhera St., Chelyabinsk 454087

Челябинск 454087, ул. Блюхера, 42

https://orcid.org/0000-0002-7435-3306ZakharovA. S.ЗахаровА. С.
Russian Federation

42 Blukhera St., Chelyabinsk 454087

Челябинск 454087, ул. Блюхера, 42

SokolovaM. I.СоколоваМ. И.
Russian Federation

42 Blukhera St., Chelyabinsk 454087

Челябинск 454087, ул. Блюхера, 42

https://orcid.org/0000-0002-6621-0284AlekseevaA. P.АлексееваА. П.
Russian Federation

42 Blukhera St., Chelyabinsk 454087

Челябинск 454087, ул. Блюхера, 42

Chelyabinsk Regional Clinical Center of Oncology and Nuclear MedicineГБУЗ «Челябинский областной клинический центр онкологии и ядерной медицины»2407202010254602407202024072020Copyright ©; 2020, Guz A.O., Fatkullin D.M., Garev A.V., Zakharov A.S., Sokolova M.I., Alekseeva A.P.Copyright ©; 2020, Гузь А.О., Фаткуллин Д.М., Гарев А.В., Захаров А.С., Соколова М.И., Алексеева А.П.2020Guz A.O., Fatkullin D.M., Garev A.V., Zakharov A.S., Sokolova M.I., Alekseeva A.P.Гузь А.О., Фаткуллин Д.М., Гарев А.В., Захаров А.С., Соколова М.И., Алексеева А.П.https://creativecommons.org/licenses/by/4.0https://ogsh.abvpress.ru/jour/article/view/527

This review analyzes the research data concerning the problem of antibiotic prophylaxis (ABP) of wound infections after various surgeries for head and neck tumors. In patients with clean wounds, ABP should be used in exceptional cases only (for example, if the patient has any risk factors), otherwise it should be avoided. A short ABP course is recommended for patients with clean-contaminated wounds; however highrisk patients may require a prolonged course. There is some evidence of ABP efficacy in patients with non-contaminated wounds after cervical lymphadenectomy. When choosing a drug for ABP, a doctor should consider the site of surgery and the risk of wound contamination. The optimal drugs after head and neck surgeries include first- and second-generation cephalosporins, ampicillin in combination with sulbactam, metronidazole, and clindamycin. First- and second-generation cephalosporins in combination with metronidazole are preferable, but if the wound is infected with gram-positive bacteria, it is necessary to use clindamycin monotherapy. Reconstructive surgeries with a free flap require a short course of ABP with one of the following combinations: cefazolin + metronidazole, cefuroxime + metronidazole, or ampicillin + sulbactam; if the patient is allergic to beta-lactams, clindamycin can be used. Despite the availability of standard ABP regimens, a surgeon must apply a tailored approach when choosing an ABP regimen for each patient, taking into account risk factors and the volume of surgery.

В настоящем обзоре проанализированы данные научной литературы по проблеме антибиотикопрофилактики (АБП) раневых инфекций при различных операциях по поводу опухолей головы и шеи. АБП при наличии чистой раны должна назначаться в исключительных случаях – при наличии факторов риска; в остальных ситуациях рекомендовано отказаться от нее. При условночистых хирургических ранах предпочтителен короткий курс АБП, но пациентам группы риска возможно назначение пролонгированного курса. Имеются данные об эффективности АБП при неконтаминированных шейных лимфаденэктомиях. При выборе препарата для АБП следует учитывать область проведения операции и риск контаминации раны. Для операций в области головы и шеи оптимальными препаратами принято считать цефалоспорины I–II поколений, ампициллин в сочетании с сульбактамом, метронидазол, клиндамицин. Цефалоспоринам I–II поколения в сочетании с метронидазолом отдается предпочтение, но при инфицировании грамположительными бактериями необходимо применение клиндамицина в монорежиме. При реконструктивных вмешательствах с использованием свободного лоскута показан короткий курс АБП следующими комбинациями препаратов: цефазолин + метронидазол, цефуроксим + метронидазол, ампициллин + сульбактам, а при аллергии на бета-лактамы – клиндамицин. Несмотря на наличие стандартных режимов АБП, хирург должен индивидуально подбирать режим АБП для каждого пациента с учетом факторов риска и объема вмешательства.

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