The Role of Antibiotic Therapy in the Management of Facial Fractures: A Systematic Review
DOI:
https://doi.org/10.12775/JEHS.2025.78.57779Keywords
mandibular fractures, maxillary fractures, antibiotic prophylaxis, antibacterial agents, postoperative antibiotic prophylaxis, mandible fracture, antibiotics, open reduction, internal fixationAbstract
Purpose:The administration of prophylactic doses of antibiotics is a standard procedure in the treatment of maxillofacial fractures. Maxillofacial fractures occur most frequently, and antibiotic therapy is often overused before and after surgery. Despite numerous studies, there are still no clear-cut treatment regimens. The present study aimed to empirically evaluate this aspect.Materials and methods:The authors conducted an extensive review of articles available in PubMed, Google Scholar, UpToDate, Science Direct, and Cochrane databases. The keywords mandibular fractures, maxillary fractures, antibiotic prophylaxis, antibacterial agents, postoperative antibiotic prophylaxis, mandible fracture; antibiotics, open reduction, internal fixation. Studies published between 1970 and 2021 were included in the review.Results:Adding postoperative antibiotic prophylaxis to the standard preoperative and/or perioperative antibiotic regimens showed no significant reduction in the risk of surgical site infections. Similarly, no difference was observed in infection risk when the analysis focused specifically on mandibular fractures or procedures involving open surgical techniques. We should also take into account the patient's general diseases that increase the risk of infection. The situation in which prophylaxis unequivocally needs to be applied is the connection of the fracture gap with the oral cavity (open fractures) or sinuses.Conclusion:The evidence for prophylactic antibiotic use in maxillofacial fractures is weak and inconsistent, with no clear recommendations on type, dose, or duration. Each treatment should be individualized and tailored to the particular clinical case. Particular attention should be paid to the patient's medical condition, comorbidities, and the type and extent of the injury. Routine antibiotic therapy in patients belonging to the low-risk group carries negative consequences, such as the development of antibiotic-positivity.
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Copyright (c) 2025 Katarzyna Michalczyk, Dominika Sobolewska, Małgorzata Wirkijowska, Wiktoria Gajek-Flanczewska , Sebastian Flanczewski, Paulina Woźniak, Ewa Wietrzykowska, Martyna Śliwińska, Anna Podraza, Katarzyna Wójtowicz, Agata Walczak
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