(40) Are Short Course Antibiotics Favorable in Oral and Maxillofacial Surgical Procedures? A Meta-Analysis

Thursday, September 15, 2022

1:30 PM – 3:00 PM CDT

Figure 1 - Third Molar Meta-Analysis Results

Figure 2 - Orthognathic Meta-Analysis Results

Figure 3 - Maxillofacial Trauma Meta-Analysis Results

Presenting Author(s)

Jerad A. Servais, DDS

Resident
Temple University Hospital
Philadelphia, Pennsylvania, United States

Co-Author(s)

RH

Raphael Huntley, DDS

Resident
Temple University Hospital
Philadelphia, Pennsylvania, United States
SA

Samer Abdelsamie, DMD

Attending Oral Surgeon
Temple University Oral Surgery
Philadelphia, Pennsylvania, United States

Disclosure(s):

Jerad A. Servais, DDS: No financial relationships to disclose

Raphael Huntley, DDS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Samer Abdelsamie, DMD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Abstract: Prophylactic antibiotics are utilized widely following oral and maxillofacial surgery procedures, but the ideal duration of antibiotics following operations is uncertain. The aim of this study was to determine amongst patients undergoing third molar, orthognathic, or maxillofacial trauma surgeries does the use of short-course antibiotic prophylaxis ( < 24 hours), as compared to extended-course antibiotic prophylaxis (>72 hours) differ in postoperative surgical site infection (SSI) rates. A PubMed literature search was completed in August 2021, which included prospective clinical trials comparing antibiotic prophylaxis courses 24 hours or less compared to 72 hours of more following oral and maxillofacial surgery procedures. The relative risks of SSI were calculated and pooled using the Mantel-Haenszel method. A total of 13 articles with 1,245 patients that underwent oral and maxillofacial surgical procedures were included in the meta-analysis. 197 patients underwent third molar procedures, 563 underwent orthognathic procedures, and 485 patients underwent trauma related oral and maxillofacial surgical procedures. Amongst each procedure type, the use of long course antibiotics was not related to lower surgical site infection rates. No statistically significant association was found between SSI and antimicrobial prophylaxis for short-course ( < 24 hours) and extended-course (>72 hours) following third molar (Figure 1), orthognathic (Figure 2), or maxillofacial trauma (Figure 3) surgical procedures. The baseline use of long term antibiotics for these patients is unfounded, and likely contributes to increased cost, patient effort, unwanted reaction risk, or secondary non-surgical-site infections. Future blinded, placebo-controlled, randomized controlled trials are indicated to determine the appropriate length of postoperative antibiotics in oral and maxillofacial surgical procedures.

Peterson LJ. Antibiotic prophylaxis against wound infections in oral and maxillofacial surgery. J Oral Maxillofac Surg. 1990 Jun;48(6):617-20.

Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283.