A protocol for prophylactic antibiotic use in managing mandibular fractures requiring open reduction and internal fixation: a prospective clinical trial
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Date
2021
Authors
Mohotlhoane, Gontse P.
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Abstract
Introduction: The use of antibiotic prophylaxis in managing mandibular fractures is a
common practice amongst maxillofacial and oral surgeons. The practices are however varied
and unclear.
Purpose: The purpose of this study was to analyze the need for long term prophylactic
antibiotic regimen following treatment of fractured mandibles with open reduction and
internal fixation.
Material and methods: A prospective, randomized controlled trial was undertaken at Wits
Oral Health Centre. Patients with mandibular fractures who were managed with open
reduction and internal fixation using mini plates via intra-oral approach were randomized into
two groups. Group 1, the control group, was composed of patients who received a 1-day IV
antibiotic cover intra-operatively and further 24 hour doses post-operatively (3 doses), before
being discharged. Group 2, the study group, was composed of patients who received similar
doses as the control group but with an additional 5 days of oral antibiotics upon discharge.
The patients were reviewed over a period of 1, 4 and 6 weeks and the presence or absence of
infection was recorded each week and analyzed.
Results: A total of 77 patients were analyzed, with 41(53.2%) in the non-antibiotic group and
36 (46.8%) in the antibiotic group. Overall infection rate at 6 weeks was 6.5% with a total of
18 patients in the non-antibiotic group and 9 patients in the antibiotic group who presented
with infections over the 6-week review period. There was no significant difference (p=0.34)
in the presence of infection between the antibiotic and the non-antibiotic groups but there was
a notable increase in post-operative infection in patients with comorbidities in the non antibiotic group.
Conclusions: The extended use of antibiotic prophylaxis when managing mandibular
fractures with open reduction and internal fixation offers no additional benefit in reducing
post-operative infection. However, patients with comorbidities might be at an increased risk
of post-operative infection and might benefit from an extended course of oral antibiotics
Description
A dissertation submitted in partial fulfilment of the requirements for the degree of Master of Dentistry to the Faculty of Health Sciences, School of Maxillofacial and Oral Surgery, University of the Witwatersrand, Johannesburg, 2021