Do We Need Prophylactic Antibiotic Use in Endoscopic Transsphenoidal Pituitary Surgery?

Background: The benefit of prophylactic antibiotic use in endoscopic endonasal transsphenoidal surgery (EETS) for pituitary lesions is controversial. Many surgeons administer antibiotics perioperatively not based on clear guidelines but “to be safe.”

Objectives: Determine if 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.

Methods: A systematic review was performed to assess the effectiveness of perioperative antibiotic use in preventing infectious complications in patients undergoing EETS. Data sources: Ovid Databases, Scopus, PubMed, Cochrane Library, Gray Literature. The inclusion criteria were: randomized controlled trials, systematic reviews, observational studies, and case series of prophylactic antibiotic perioperative use for EETS. The study end points were the rates of meningitis and sinusitis as infectious complications after EETS.

Results: A total of 282 articles were identified by the initial literature search. Four studies met the inclusion criteria: three retrospective cohort and one prospective case series studies. All patients included in each study received different antibiotic regimens perioperatively. The quality of studies did not permit performance of a meta-analysis.

Conclusion: Even though there are no clear practice guidelines regarding the antibiotic prophylaxis need in EETS, various antibiotic regimens have been used by surgeons. Our systematic review identified a limited number of published studies assessing this question, all observational. Randomized control trials are needed to evaluate the effectiveness of prophylactic antibiotic use in patients with pituitary lesions undergoing EETS.

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