Systemic Antibiotic Prophylaxis in Maxillofacial Trauma: A Scoping Review and Critical Appraisal

Abstract

Infection after maxillofacial trauma remains an important complication, with a significant socio-economic impact. While consensus exists that systemic antibiotic prophylaxis reduces the risk of infection in the management of maxillofacial fractures, the type, and duration remain controversial. Therefore, the purpose of this scoping review was to provide an overview of the current evidence that supports the use of prophylactic antibiotics in the treatment of maxillofacial fractures. A comprehensive literature search on 1 January 2022, in PubMed, Web of Science, Embase, and Cochrane, revealed 16 articles. Most studies focused on the duration of systemic antibiotic prophylaxis and compared a one-day to a five-day regimen. Included studies showed considerable variability in design and research aims, which rendered them difficult to compare. Furthermore, a variety of antibiotic regimens were used, and most studies had a short follow-up period and unclear outcome parameters. This scoping review demonstrates the lack of well-constructed studies investigating the type and duration of systemic antibiotic prophylaxis in the treatment of maxillofacial trauma. Based on the included articles, prolonging antibiotic prophylaxis over 24 h for surgically treated fractures does not appear to be beneficial. Furthermore, there is no evidence for its use in conservatively treated fractures. These results should be interpreted with caution since all included studies had limitations.

Prophylactic antibiotic use for penetrating trauma in prolonged casualty care: A review of the literature and current guidelines

“…In mandibular trauma, the preponderance of the data suggests that AP reduces infection rates, but multiple systematic reviews and meta-analyses have failed to determine an optimal regimen. No benefit has been demonstrated from prolonged courses of antibiotics, with most studies and the resulting guidelines concluding that AP can be limited to the perioperative period but noting poor quality of the evidence 5,32–41 . Similar to other injury locations, cefazolin is the preferred AP in combat-related trauma, to be administered for 1 day following surgery; clindamycin is an acceptable alternative 2,41 …”

“…No benefit has been demonstrated from prolonged courses of antibiotics, with most studies and the resulting guidelines concluding that AP can be limited to the perioperative period but noting poor quality of the evidence. 5,[32][33][34][35][36][37][38][39][40][41] Similar to other injury locations, cefazolin is the preferred AP in combatrelated trauma, to be administered for 1 day following surgery; clindamycin is an acceptable alternative. 2,41…”

Antibiotic prophylaxis in injury: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document

“…Discussion : Fractures of the upper one-third of the face (including fractures of the frontal sinus that do not involve the posterior table), middle one-third of the face (including LeFort fractures, zygomaticomaxillary complex fractures, orbital fractures, maxillary sinus wall, and nasal bone fractures), and lower one-third of the face (non-dentate segments of the mandible) are considered non-contaminated fractures and have a lower frequency of postoperative infections. 18 Therefore, continuing prophylactic antibiotics beyond 24 hours after surgical fixation is not recommended without documented infection. This is based on findings from multiple studies of mandibular and non-mandibular fractures that found no significant difference in infection rates between patients who received preoperative or postoperative antibiotics versus those who did not.…”

“…9 In a review of antibiotic prophylaxis in facial trauma by Goormans et al, none of the included studies found a statistically significant benefit of prolonging antibiotic prophylaxis beyond 24 hours. 18 In fact, some studies noted a significantly increased infection rate for patients who received antibiotic prophylaxis for more than 1 day. [19][20][21] In terms of the recommended antibiotic type, no studies have compared the effect of different types of antibiotics on infection rates so the most suitable antibiotic for maxillofacial trauma is unknown.…”

Case Management of Anterior Tooth Intrusion Due to Trauma

“…13,14 Penelitian lain menyatakan penggunaan antibiotik profilaksis selama 24 jam paska tindakan perawatan pada kasus fraktur maksila memberikan hasil positif untuk mencegah penyebaran infeksi. 15 Penyembuhan pada kasus trauma yang melibatkan fraktur pada tulang juga dapat dioptimalkan dengan penggunaan kalsium. 16 Sehingga kombinasi antibiotik dan kalsium dapat mempercepat penyembuhan.…”