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If the urine is infected, it is preferable to sterilize it before beginning an elective procedure. 13. HEAD AND NECK SURGERY • Tonsillectomy with/without adenoidectomy Data regarding prophylaxis are not available. • Major head, neck and oral surgery If incision is through oral or oropharyngeal mucosa: • Cefazolin 2 g IV as single dose OR Amoxycillin-clavulanate IV 1,2 g as single dose OR Gentamicin 80mg PLUS clindamycin 600mg IV as single doses Rhinoplasty Prophylactic antibiotics have not proved effective.

The continued use of antibiotic because of effusion, is not indicated: refer for consideration of tympanostomy tube placement. M as to i d i ti s Pathogens and treatment are as for otitis media. An urgent specialist ENT opinion is advisable, as surgery may be necessary. Oti ti s e x te r n a Most are due to so-called “swimmer’s ear” and the pathogens involved are us-ually Pseudomonas aeruginosa, Proteus mirabilis or other Gram-negative bacteria. Treatment: Clean the external ear canal with an acidic solution, such as 2% acetic acid.

G. cipro-floxacin, when appropriate. Surgical debridement is often required. S i n u s i ti s Common pathogens: Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Anaerobes play a significant role in adult sinusitis especially if persistent - so-called “chronic sinusitis”. Treatment: Topical decongestant for 5 days (systemic decongestants are not recommended). Amoxycillin 500 mg three times daily (80 - 100 mg/kg/day in children) for 10 - 14 days is the treatment of choice for acute sinusitis.

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