Antibiotic prophylaxis in orthognathic surgery: A complex systematic review.

Aron Naimi-Akbar,Bodil Lund,Anna Klinge,Margareta Hultin,Sofia Tranæus,Björn Klinge,Gururaj Arakeri

doi:10.1371/journal.pone.0191161

Aron Naimi-Akbar, Bodil Lund + Show 5 more

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https://doi.org/10.1371/journal.pone.0191161

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Abstract

ObjectiveIn orthognathic surgery, antibiotics are prescribed to reduce the risk of postoperative infection. However, there is lack of consensus over the appropriate drug, the dose and duration of administration. The aim of this complex systematic review was to assess the effect of antibiotics on postoperative infections in orthognathic surgery.MethodsBoth systematic reviews and primary studies were assessed. Medline (OVID), The Cochrane Library (Wiley) and EMBASE (embase.com), PubMed (non-indexed articles) and Health Technology Assessment (HTA) publications were searched. The primary studies were assessed using GRADE and the systematic reviews by AMSTAR.ResultsScreening of abstracts yielded 6 systematic reviews and 36 primary studies warranting full text scrutiny. In total,14 primary studies were assessed for risk of bias. Assessment of the included systematic reviews identified two studies with a moderate risk of bias, due to inclusion in the meta-analyses of primary studies with a high risk of bias. Quality assessment of the primary studies disclosed one with a moderate risk of bias and one with a low risk. The former compared a single dose of antibiotic with 24 hour prophylaxis using the same antibiotic; the latter compared oral and intravenous administration of antibiotics. Given the limited number of acceptable studies, no statistical analysis was undertaken, as it was unlikely to contribute any relevant information.ConclusionWith 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.

Highlights

Antibiotic prophylaxis to reduce the risk of postoperative infection after orthognathic surgery is a broadly accepted practice
The outcomes of numerous treatment procedures are dependent on effective infection control and treatment, antibiotic resistance poses a major threat to modern healthcare,[5]
Studies considered eligible for inclusion in this literature review were randomised controlled trials (RCT), systematic reviews and meta-analyses of the outcome of orthognathic surgery undertaken with or without antibiotic cover

Summary

Introduction

Antibiotic prophylaxis to reduce the risk of postoperative infection after orthognathic surgery is a broadly accepted practice. Because of increasing antibiotic resistance, it is important to assess the potential benefits and risks associated with administration of antibiotics. The outcomes of numerous treatment procedures are dependent on effective infection control and treatment, antibiotic resistance poses a major threat to modern healthcare,[5]. The development of antibiotic resistance is closely related to the extent of prescription and rational antibiotic usage is an increasingly important preventive measure [7–9]. The benefit of restrictive antibiotic policies is evident in low consumption environments, where the levels of resistance are relatively low [10]. It has been shown that short- term use of antibiotics, even a single dose, may select for resistant viridans streptococci. Short- term utilisation, such as antibiotic prophylaxis, needs to be reassessed[11, 12]

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