Are prophylactic antibiotics justified in pediatric patients with inguinal hernia repair?


Background: There are different studies highlighting the role of using prophylactic antibiotics in clean surgeries, but still there is conflicting evidence regarding whether prophylactic antibiotics are beneficial or not in preventing post-operative surgical site infection. Aim: This study aims to evaluate the use of peri-operative prophylactic antibiotics in preventing or reducing surgical site infection in the elective open repair of pediatric inguinal hernia. Patients and method: Over a ten-month period a total 150 pediatric patients underwent elective surgical repair for inguinal hernia were enrolled in this randomized prospective study, they were categorized into two equal Groups alternating at the time of operation. The patients in group A (Control) were followed a standard regimen of giving pre-operative parenteral antibiotic (in the ward or at the beginning of anesthesia) & then post-operative oral antibiotics for five days duration, while the patients in group B (Case) underwent the same surgery, but neither preoperative nor post-operative antibiotics were given. A written informed consent from the parents or child guardian was obtained after explanation. The rate of surgical site infection was compared between the two groups. A p value of less than 0.05 was considered to be significant statistically. Results: The total infection rate in both (case and control groups) was 3.33%, the rate of postoperative wound infection in "case group" was 4 % compared to that in "control group" which was 2.67 %. This noticed variance was statistically insignificant (P value by Chi-Square Test = 0.9883, Two –tailed p value using paired samples- t test was = 0.6578). 80% of the infections were mild (grade 1 & 2) & 60% was noticed in the 3rd post-operative day. Conclusion: This study pointed out that peri-operative prophylactic antibiotics are not justified routinely in pediatric inguinal herniotomy as there is no significant increased risk of postoperative wound infection in "group B" compared to "group A" (p value = 0.6578 using paired samples t- test), & this low risk of wound infection does not warrant the economic burden of their usage in such clean surgical operations.