February 06, 2019
1 min read

Guideline urges physicians to stop prescribing antibiotics, codeine for tonsillectomies

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Photo of Ron B. Mitchell
Ron B. Mitchell

The American Academy of Otolaryngology–Head and Neck Surgery Foundation has made strong recommendations against the use of codeine and perioperative antibiotics in pediatric patients undergoing tonsillectomy.

Ron B. Mitchell, MD, chair of the guideline update group and director of the otolaryngology division at Children’s Health, told Infectious Diseases in Children that the guideline now includes an “extensive amount” of information on education, counseling and pain management.

“The information is updated with the best available evidence on indications for tonsillectomy and the management of children before, during and after surgery,” Mitchell said. “Following the key action statements in the guideline is very important because it will ensure the best quality of care in children undergoing tonsillectomy.”

For example, physicians should employ a “watchful waiting” approach to treatment as opposed to immediately treating children with recurrent throat infection, particularly if the child has had less than seven episodes within the year, less than five episodes per year in the past 2 years, or less than three episodes per year in the past 3 years. Additionally, a single intraoperative dose of dexamethasone should be administered to children undergoing tonsillectomy, as well as ibuprofen, acetaminophen or both for pain relief following the procedure.

The guideline authors strongly recommended against the prescription or administration of perioperative antibiotics to children undergoing the procedure.

Mitchell said the prescription of perioperative antibiotics is a “common but not universal practice.”

“The evidence that routine use of antibiotics with tonsillectomy is contraindicated is overwhelming,” he said. “It is based on a large amount of data, including a meta-analysis of studies from within and outside the USA.”

The authors also strongly recommended against giving children aged 12 years and younger codeine or any medication containing codeine after a tonsillectomy.

They noted that 289,000 ambulatory tonsillectomy procedures are performed every year in children aged 15 years and younger, and that the updated guideline is intended for any clinician who interacts with patients aged 18 years and younger who may be a candidate for the procedure. – by Katherine Bortz


Mitchell RB, et al. Otolaryngol Head Neck Surg. 2019;doi:10.1177/0194599818801757.

Chua KP, et al. Pediatrics. 2017;doi:10.1542/peds.2017-1765.

Disclosures: Mitchell reports no relevant financial disclosures. Please see the guideline for all other authors’ relevant financial disclosures.