Antibiotic Prophylaxis in Orbital Fractures

Abstract

Purpose:To determine whether prophylactic antibiotic use in patients with orbital fracture prevent orbital infection.Design:Retrospective cohort study.Participants:All patients diagnosed with orbital fracture between January 1, 2008 and March 1, 2014 at The George Washington University Hospital and Clinics.Main Outcome Measures:Development of orbital infection.Results:One hundred seventy-two patients with orbital fracture met our inclusion and exclusion criteria. No orbital infections were documented. Twenty subjects (12%) received no prophylactic antibiotic, and two (1%) received only one dose of antibiotics pre-operatively for surgery. For primary antibiotic, 136 subjects (79%) received oral antibiotics, and 14 (8%) received intravenous (IV) antibiotics (excluding cefazolin). Cephalexin and amoxicillin-clavulanate were the most prescribed oral antibiotics that are equally effective. Five-to-seven day courses of antibiotics had no increased infections compared to ten-to-fourteen day courses. Calculated boundaries for effectiveness of prophylactic antibiotics ranged from a Number Needed to Treat (NNT) of 75 to a Number Needed to Harm (NNH) of 198.Conclusion:Antibiotics for prevention of orbital infection in patients with orbital fractures have become widely used. Coordination between trauma teams and specialists is needed to prevent patient overmedication and antibiotic resistance. Should antibiotics be used, shorter courses and avoidance of broad spectrum agents are recommended. Additional studies are needed.

Postoperative prophylactic antibiotics for facial fractures: A systematic review and meta‐analysis

“…Table summarizes the eight studies that were excluded from our meta‐analysis . None of the studies found a significant benefit of postoperative antibiotic prophylaxis in reducing infection rates.…”

“…None of the studies found a significant benefit of postoperative antibiotic prophylaxis in reducing infection rates. Reiss et al suggested that for low‐risk facial fracture patients, antibiotic prophylaxis may not be necessary . Amin et al found no significant difference in infection rates regardless of duration of postoperative antibiotic prophylaxis …”

“…Future trials should also delineate more clearly the differences in infection risk between preoperative (<2 hours prior to surgery) and perioperative prophylaxis (2 hours before surgery to 24 hours after surgery). Although current practice has accepted the efficacy of perioperative prophylactic antibiotics based primarily on the findings of Zallen and Curry and Chole and Yee, more recent studies have questioned whether patients undergoing maxillofacial surgery should receive prophylactic antibiotics at all, especially for low‐risk cases . Finally, because infection could occur weeks after surgery, future trials should consider whether leveraging the ubiquitous electronic health record may help to increase the follow‐up window.…”

“…We identified eight studies that met our inclusion criteria, but did not provide data in a format amenable to meta-analysis. [24][25][26][27][28][29][30][31] We were able to obtain contact information for the authors of three of these studies and reached out via email. 24,27,30 Because we did not receive a response, we excluded those studies from our meta-analysis.…”

“…37,44 Table II summarizes the eight studies that were excluded from our meta-analysis. [24][25][26][27][28][29][30][31] None of the studies found a significant benefit of postoperative antibiotic prophylaxis in reducing infection rates. Reiss et al suggested that for low-risk facial fracture patients, antibiotic prophylaxis may not be necessary.…”