Perioperative Antibiotic Use in Head and Neck Surgery

Importance Perioperative antibiotic prophylaxis in head and neck surgery remains poorly standardized internationally, despite evidence supporting short-course regimens and showing no benefit in low-risk procedures. Contemporary international data on prescribing practice are limited. Objectives To characterize international patterns of perioperative antibiotic use in endocrine and oncologic head and neck surgery and to identify discrepancies between reported practice and evidence-based recommendations. Design, Setting, and Participants In this survey study, a cross-sectional survey was distributed electronically between October 1, 2024, and December 31, 2025, through national and international professional societies. Respondents were classified by country of practice into Europe, North America, and rest of world. Data were analyzed in June 2026. Main Outcomes and Measures Routine antibiotic use, agent selection, and duration of prophylaxis across 6 procedure categories (conventional thyroidectomy, completion thyroidectomy, complex thyroidectomy, low-risk head and neck squamous cell carcinoma [HNSCC], low-complexity HNSCC, and complex clean-contaminated HNSCC). Secondary outcomes were departmental guideline availability and circumstances prompting antibiotic use. Results Of 468 respondents (310 of 419 [74%] with available data reported male sex or gender, 32 of 432 [82%] otolaryngologists–head and neck surgeons and 283 of 431 [66%] in academic practice), routine antibiotic use for conventional thyroidectomy was reported by 12% (95% CI, 8%-19%) of European, 35% (95% CI, 27%-44%) of North American, and 56% (95% CI, 39%-71%) of rest of world respondents. For clean-contaminated HNSCC, prophylaxis use ranged from 93% to 99%, with aminopenicillin plus a β-lactamase inhibitor preferred in Europe (66%) and North America (64%); cefazolin predominated in North America (47%) and cefuroxime in Europe (31%). For low-complexity clean-contaminated procedures, 24-hour regimens were reported by 43% (95% CI, 34%–53%) of North American vs 11% (95% CI, 7%–16%) of European respondents, whereas 7-day courses were reported by 23% (95% CI, 17%–29%) of European vs 8% (95% CI, 4%–15%) of North American respondents. Departmental HNSCC guidelines were more available in Europe than North America (83% vs 38%). Conclusions and Relevance In this survey study of 468 head and neck surgeons, perioperative antibiotic prescribing was heterogeneous internationally, with routine use in clean procedures and prolonged regimens for clean-contaminated surgery. Departmental guideline availability did not correspond to shorter reported prophylaxis duration, suggesting that implementation rather than guideline existence may be the target for antimicrobial stewardship.