A Systematic Review of Perioperative Versus Prophylactic Antibiotics for Cochlear Implantation

Background: Previous Cochrane review of prophylactic antibiotic use in clean and clean-contaminated ear surgery showed no benefit; however, these studies did not address cochlear implant (CI) surgery specifically. Objective: Systematically review effects of perioperative antibiotics on risk of infections and related complications in CI surgery Search methods: PubMed, EMBASE, Medline, CINAHL, and Cochrane library were searched from inception to March 2015. Manual searches of bibliographies were also completed. Selection Criteria: We included all studies that describe perioperative antibiotic use in CI surgery. Outcome measures included infection, meningitis, implant extrusion, and adverse antibiotics effects. Two independent evaluators reviewed each abstract and article. Results: One hundred and seventy-three studies were identified in search. Three met inclusion criteria and were reviewed. Articles were low quality; no randomized trials were identified. For included studies, numerous antibiotic types and dosing regimens were used. Recorded outcome measures were heterogeneous, and detailed information was frequently unavailable. Overall infection rate was low (3%-4.5%); single dose antibiotic prophylaxis showed low rate of complications (1%) in 2 studies. Conclusions: There is insufficient evidence to make definitive conclusions about the role of perioperative antibiotics in CI surgery. Reported infection rates are low; however, decision to use antibiotics should be based on assessment of risks and benefits to each patient.