The use of antibiotic prophylaxis to reduce the risk of postoperative infection following orthognathic surgery is commonplace. However, there is considerable variation in relation to the preferred antibiotic, dose, duration of route of administration.

The aim of the review was to assess the effect of antibiotics on postoperative infections in orthognathic surgery.

Methods

Searches were conducted in the Medline/PubMed, Cochrane Library, Embase and Health Technology Assessment databases. Randomised controlled trials (RCTs) and systematic reviews and meta-analysis assessing orthognathic surgery outcomes with or without antibiotic cover were considered.  Three reviewers selected studies with AMSTAR being used to assess the quality of systematic reviews and GRADE for the primary studies. No statistical analysis was undertaken.

Result

• 6 systematic reviews and 36 primary studies had a full text assessment.
• 4 systematic reviews were considered to be at high risk of bias and 2 at moderate risk.
• 14 primary studies were assessed for risk of bias, 12 were considered to be at high risk of bias
• 2 RCTs (1 at low risk and 1 at moderate risk) were summarised. One compared a single dose of antibiotic with 24-hour prophylaxis using the same antibiotic; the second compared oral and intravenous administration of antibiotics. Both studies concluded that the use of antibiotics in orthognathic surgery was beneficial.

Conclusions

The authors concluded: –

With respect to antibiotic prophylaxis in orthognathic surgery, most of the studies to date have been poorly conducted and reported. Thus scientific uncertainty remains as to the preferred antibiotic and the optimal duration of administration.

Comments

The authors have taken a robust methodological approach to this review identifying that the majority of studies undertaken to date have important quality limitations.  A 2015 review of the same question published by the Cochrane Wounds group (Dental Elf – 16^h Jan 2015) which was discussed by the authors included 11 RCTs and concluded: –

For people undergoing orthognathic surgery, long term antibiotic prophylaxis decreases the risk of surgical site infection (SSI) compared with short-term antibiotic prophylaxis and the is uncertainty of whether short-term antibiotic prophylaxis decreases SSI risk relative to a single pre-operative dose of prophylactic antibiotics.

Of the 11 studies included in the Cochrane review 5 were considered to be at high risk of bias, 5 at unclear risk of bias and 1 low risk of bias. Some may disagree with the approach taken by the authors of this review. However, with increasing concerns regarding antibiotic resistance there is clearly the need for additional studies to clarify , if there is a clear need for antibiotic prophylaxis after orthognathic surgery and what is the most effective antibiotic regime.

Links

Primary Paper

Naimi-Akbar A, Hultin M, Klinge A, Klinge B, Tranæus S, Lund B. Antibiotic prophylaxis in orthognathic surgery: A complex systematic review. PLoS One. 2018 Jan 31;13(1):e0191161. doi: 10.1371/journal.pone.0191161. eCollection 2018. PubMed PMID: 29385159; PubMed Central PMCID: PMC5791956.

Other references

Dental Elf – 12^th Aug 2016

Third molar removal: antibiotics reduced risk of dry socket

Dental Elf – 16^h Jan 2015

Orthognathic surgery: antibiotic prophylaxis reduced surgical site infection