Utility of Prophylactic Antibiotics in Nonoperative Facial Fractures

Abstract

Facial fractures are commonly managed nonoperatively. Patients with facial fractures involving sinus cavities commonly receive 7 to 10 days of prophylactic antibiotics, yet no literature exists to support or refute this practice. The aim of this study was to compare the administration and duration of antibiotic prophylaxis on the incidence of soft tissue infection in nonoperative facial fractures. A total number of 289 patients who were admitted to our level I trauma center with nonoperative facial fractures from the beginning of 2012 to the end of 2014 were studied. Patients were categorized into 3 groups: no antibiotic prophylaxis, short-term antibiotic prophylaxis (1-5 days), and long-term antibiotic prophylaxis (>5 days). The primary outcome was the incidence of facial soft tissue infection and Clostridium difficile colitis. Fifty patients received no antibiotic prophylaxis. Sixty-three patients completed a short course of antibiotic prophylaxis and 176 patients received long-term antibiotics. Ampicillin/sulbactam, amoxicillin/clavulanic acid, or a combination of both were used in 216 patients. Twenty-three patients received clindamycin due to penicillin allergy. Short and long courses of antibiotic prophylaxis were administered more commonly in patients with concomitant maxillary and orbital fractures (P <0.0001). No mortality was found in any group. Soft tissue infection was not identified in any patient. C. difficile colitis was identified in 1 patient who had received a long course of antibiotic prophylaxis (P = 0.7246). There was no difference in the outcome of patients receiving short-term, long-term, and no antibiotic prophylaxis. Prospective randomized studies are needed to provide further clinical recommendations.

No Reduction in Surgical Site Infection Obtained with Post-Operative Antibiotics in Facial Fractures, Regardless of Duration or Anatomic Location: A Systematic Review and Meta-Analysis

“…PAP with open reduction and internal fixation of facial fractures (ORIFfx) likely is unnecessary [6][7][8][9][10][11][12][13][14]. Despite these findings, a review from 2015 included a survey of US plastic surgeons that found that 75% employ PAP routinely for >24 hours, and the majority of respondents reported continuing antibiotic prophylaxis for at least one week [15].…”

A Review of Frontal Orbital and Frontal Sinus Fractures and Associated Ocular Injuries - Level I Trauma Center - University Hospital Experience

“…There remains controversy in the current literature regarding the benefits of prophylactic antibiotics in these patients, as good quality prospective data is lacking. [13][14][15] The treatment of these complex facial fractures can vary depending on several factors. These include the fracture pattern, degree of posterior table involvement, nasofrontal duct injury, neurological status, concomitant head injury, presence of CSF leak, and retinal detachment, which may preclude surgical access to the patient.…”

“…[12][13][14] Protective equipment, in some cases, has reduced the frequency of catastrophic injuries. 7,15 Despite the growing medical and economic implications of pediatric traumas, 16 particularly craniofacial traumas, existing literature suffers from small sample sizes 4,17 and/or outdated data. 18 Additionally, many pediatric trauma studies restrict inclusion criteria to patients under the age of 18; yet postpubertal physiologic development may continue well into early adulthood.…”

Lateral nasal wall abscess following manipulation of fractured nasal bones

“…Prophylactic antibiotics are not prescribed routinely for patients with a nasal fracture or those undergoing MUA. Evidence has suggested a little benefit of prophylactic antibiotics in facial fractures overall, save for mandibular fractures 15. Likewise, the use of prophylactic antibiotics in nasal surgery is controversial, and typically only recommended if endonasal packing has been applied 16.…”