Otolaryngology is an expanding field with septoplasty and rhinoplasty encompassing some of the most routinely performed procedures, often jointly performed as a septorhinoplasty (SRP) [1]. Together, these clean-contaminated procedures can provide both aesthetic and functional improvements in patients' lives by improving nasal air flow and relieving chronic sinus obstruction [2]. However, the natural bacterial flora of the nares raises concerns regarding postoperative infections leading to the widespread utilization of prophylactic antibiotics [3].

While rare, infections after septoplasty, rhinoplasty, and SRP surgeries have been shown to cause significant effects such as toxic shock syndrome, abscesses, scarring, and in rare instances, complications like saddle nose deformity and supratip depression. These conditions can necessitate additional surgical interventions and extended hospitalization, leading to higher medical expenses for both patients and healthcare facilities [[4], [5], [6], [7]]. Due to concerns about the uncommon but serious complications of infection, the use of antibiotics has increased in the preoperative, intraoperative, and postoperative settings [7,8]. However, the use of antibiotics comes with risks such as over prescription leading to microbial resistance leading to a potential public health crisis as well as individualized health risks such as the development of inflammatory bowel disease, asthma, or novel allergic reactions. [2,[9], [10], [11]]

While the WHO global guidelines for the prevention of surgical site infection only recommend irrigation in clean-contaminated surgery, the most recent guidelines from the American Association of Plastic Surgeons recommend the use of prophylactic antibiotics in clean and clean-contaminated head and neck procedures [12,13]. Studies on the topic have reported conflicting findings in regards to the efficacy of such practice [[14], [15], [16]]. The timing of prophylaxis antibiotic administration has also been called into question with various studies utilizing preoperative, perioperative, postoperative, or a combination thereof antibiotics [3,14,15]. This lack of consensus has created an environment where antibiotics are prescribed inconsistently based on variable personal rationale that has the potential to expose patients to unnecessary risks [17,18].

Moreover, prior systematic reviews have exhibited inconsistencies and were constrained by limited data, thereby not providing current, evidence-based guidelines [19]. Consequently, this study focuses on evaluating the effectiveness of prophylactic antibiotic use in septoplasty, rhinoplasty, and SRP concerning post-surgical infection complications. From our analysis of the available data, we aim to recommend evidence-based guidelines on the use of prophylactic antibiotics and their impact on surgical outcomes in these procedures.