Duration of Therapy With Amoxicillin/Clavulanate for Postoperative Antimicrobial Prophylaxis of Fractures of the Facial Skeleton: A Systematic Review and Meta-Analysis.

BACKGROUND

The optimal duration of antibiotic therapy for fractures of the facial skeleton remains uncertain, particularly regarding the balance between efficacy and safety.

PURPOSE: This systematic review and meta-analysis aimed to evaluate the efficacy, safety, and appropriate duration of amoxicillin-clavulanate (AM-C) prophylaxis in patients undergoing surgical intervention of facial fractures.

DATA SOURCES: A comprehensive search of PubMed, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was conducted through December 2024. The search included terms such as "maxillofacial injuries" AND "amoxicillin-potassium clavulanate combination" and was limited to human studies and full-text publications.

STUDY SELECTION: Eligible studies assessed AM-C use, duration, and safety in surgically managed facial fractures. Included designs were randomized controlled trials (RCTs), prospective studies, and retrospective cohorts. Studies lacking details on antibiotic regimen, duration, or outcomes were excluded.

DATA EXTRACTION AND SYNTHESIS: Data were extracted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including infection rates, adverse events, and definitions of therapy duration. Risk of bias was assessed using the Cochrane Risk of Bias tool and ROBINS-I framework. Meta-analysis of RCTs was performed using a common effect model, with P values <0.05 considered statistically significant.

MAIN OUTCOMES AND MEASURES: Efficacy was defined by perioperative infection rates; safety by incidence of antibiotic-related adverse events.

RESULTS

Twelve studies met the inclusion criteria, comprising 270 patients from 4 RCTs and a total of 3,115 patients. Meta-analysis showed no significant difference in infection rates between short (≤24 hours) and long (>24 hours) perioperative AM-C regimens (odds ratio = 0.86; 95% CI, 0.40 to 1.84; P = .783). Adverse effects, including gastrointestinal symptoms and Clostridium difficile infection, were more common with prolonged therapy but did not reach statistical significance (odds ratio = 0.55; 95% CI, 0.11 to 2.62; P = .867). Observational studies supported these findings.

CONCLUSION AND RELEVANCE: Short-duration AM-C perioperative prophylaxis appears sufficient for preventing infections in facial fracture surgery, with fewer adverse effects and reduced antibiotic exposure, supporting antimicrobial stewardship principles.