How long should antibiotics be administered following orthognathic surgical procedures? A prospective double-blind pilot study

Abstract

Statement of the Problem: Controversy continues to exist regarding the need of postoperative antibiotics for patients undergoing orthognathic surgery. The objective of this study is to compare the administration of a oneday versus a five-day antibiotic regimen following intraoral orthognathic surgery. Materials and Methods: Thirty-seven healthy patients underwent various orthognathic surgical procedures performed aseptically by the same team of surgeons between October 2003 and December 2004. Patients were assigned into a one-day or a five-day group based on the length of time of administration of antibiotics postoperatively. All patients received one dose of intravenous Penicillin Na (mandible/chin) or Cephazolin (maxilla) preoperatively and for 24 hours postoperatively. The five-day group received intraoral Penicillin VK or Cephalexin for an additional 4 days. Assessment of infection was performed by the surgeon who is blinded to the antibiotic regimen. The parameters recorded included age, gender, type of procedure, duration of procedure, amount of irrigation used, and the presence or absence of infection. Postoperative infection was defined as the presence of one or more of the following: purulent discharge, consistent or increasing swelling for more than 5 days, axillary temperature greater than 38° Celsius after 72 hours and erythema or pain 72 hours postoperatively. Postoperative inflammation was defined as the presence of a swelling within the first four days, fever less than 38° Celsius or erythema or pain in the first 72 hours postoperatively. Assessment took place at the following time intervals: 24 hours, 48 hours, 1 week, 4 weeks and 3 months postoperatively. Method of Data Analysis: Data were analyzed using multivariate analysis and the statistical software SPSS. Results: The sample included 23 females (62.2%) and 14 males (37.8%). The mean age was 22.3 years (14 to 52). The various surgical procedures were distributed as follows: mandible (21.6%), maxilla (16.2%), maxilla/mandible/chin (16.2%), maxilla/chin (10.8%), mandible/chin (13.5%), and maxilla/mandible (21.6%). Less than one liter of irrigation was used in 55% of the surgeries, whereas between 1 and 1.5 liters of irrigation was used in 38.9% of the cases. More than 1.5 liters of irrigation was used in 6.1% of the cases. Infection was present in one patient who had a mandibular osteotomy in the 5-day group. There was a significant correlation between duration of the surgical procedure and the type of surgery performed (P .05) and amount of irrigation used (P .05). Conclusion: The results of this pilot study do not support the need for administration of a 5-day antibiotic regimen following orthognathic surgery.