Antibiotic prophylaxis to prevent local infection in Oral Surgery: Use or abuse?

ABSTRACT

Antibiotics have a well-documented efficacy in the treatment of established infections and as prophylactic agents in medicallycompromised patients. However, the systematic administration of antibiotics to prevent local infections in fit patientsis much more controversial. The aim of this paper is to reflect on the justification for prophylactic usage of antibiotics toprevent wound infection and to reason out the most appropriate antibiotic guidelines taking into account available scientificdata and studies by other authors. Numerous clinical trials question the efficacy of antibiotics in preventing woundinfection. While some studies establish that antibiotics reduce the incidence of postoperative infections, others comparetheir efficacy to that of placebo. Thus, scientific literature suggests that every oral surgical intervention is not tributaryof systematic antibiotic prophylaxis to prevent local infections. Intrinsic surgical risk factors and the patient’s individualcircumstances must be taken into account. Even though the efficacy of other antibiotics cannot be ruled out due to ourlimited comprehension of the bacteriologic interrelations intervening in the pathogenesis of postextraction local infection,the amoxicillin-clavulanic acid combination theoretically covers the complete odontogenic bacterial spectrum in Spain.When the prophylactic use of antibiotics is indicated, this should be performed preoperatively, at high doses, and its extentshould not exceed 24 hours. Special attention should be paid to antiinfectious local measures that can minimize infectionrisk during the wound’s healing period (AU)