Long-term antibiotic prophylaxis regimen compared to short-term antibiotic prophylaxis regimen in patients undergoing orthognathic surgery

Abstract

INTRODUCTION Orthognathic surgery, being an invasive surgical procedure, may present significant postoperative morbidities for the patient. Among the most frequently described complications is surgical site infection. The administration of prophylactic antibiotics prior to this type of procedure is a common practice, however, the cost-benefit of the use of antibiotics, the type of antibiotics, the route of administration, the dosage, and the regimen to be used have not been clearly defined and are still considered a controversial issue. In this summary of evidence, we will compare long-term antibiotic prophylaxis with short-term prophylaxis. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified five systematic reviews including nine studies overall, of which all nine were randomized trials. We conclude that administering a long-term prophylactic antibiotic regimen probably decreases the risk of surgical site infection and that it may increase the risk of hospital stay longer than two days, nevertheless, regarding this last point, the certainty of the evidence is low.

Surgical site infections in orthognathic surgery: prolonged versus single-dose antibiotic prophylaxis

“…Besides haemorrhage, nerve transection, and nasal septum deviations, SSIs are amongst the most frequent complications. 1,18 Among other reasons, this can be attributed to the use of intraoral surgical approaches in orthognathic surgery, which may result in contamination with endogenous bacteria. The prevalence of SSIs ranges between 1% and 33.4%.…”

“…Moreover, prolonged antibiotic prophylaxis has been described as advantageous in reducing the infection rate compared to preoperative singledose antibiotic prophylaxis. 1,18 Furthermore, numerous others have successfully shown the benefit of longterm antibiotic prophylaxis over shortterm use in the prevention of SSI. 1,18 Danda et al 11 even described the clinical advantage of a 1-day regimen compared to a single-dose antibiotic prophylaxis; however, no statistical difference was found.…”

“…Orthognathic surgical procedures are common surgical interventions in the field of maxillofacial surgery that allow the correction of skeletal malocclusion to improve occlusal function, facial harmony, and aesthetics. 1 Orthognathic surgery is generally considered safe, however it continues to be associated with numerous complications. What is more, postoperative wound infections are amongst the most common and most severe sequelae that Please cite this article as: B. Remschmidt, M. Schwaiger, J. Gaessler et al, Surgical site infections in orthognathic surgery: prolonged versus single-dose antibiotic prophylaxis, Int.…”

“…4,9,10 Hence, the clinical guidelines published by the American and British associations of oral and maxillofacial surgeons (AAOMS, BAOMS) recommend the judicious use of antibiotic prophylaxis to reduce the risk of postoperative complications. 1 However, no consensus has yet been reached regarding the type, dose, interval, and duration of prophylactic antibiotics. 1,4,11 Numerous different prophylactic antibiotic regimens are currently in use, but none have proven to be superior in reducing SSIs.…”

“…1 However, no consensus has yet been reached regarding the type, dose, interval, and duration of prophylactic antibiotics. 1,4,11 Numerous different prophylactic antibiotic regimens are currently in use, but none have proven to be superior in reducing SSIs. 4 Moreover, the use of antibiotics should be minimized to prevent antimicrobial resistance and side effects (e.g.…”