Antibiotic selection for open reduction internal fixation of mandible fractures

Many mandible fractures are treated using open reduction internal fixation (ORIF) because of its superior stabilization of the fracture line, better healing, and faster recovery while minimizing the duration of immobilization of the mandible. However, ORIF requires an incision, which can lead to one of the most common complications of a mandibular fracture repair: postoperative wound infection. Historical controls have shown the infection rate after such surgeries to be anywhere from 6% to 32%. Most of the infections are due to normal oral flora, which is a mix of diverse facultative and obligate anaerobes. The current study was undertaken to determine whether a specific antibiotic regimen should be recommended to cover the normal flora. A retrospective review of 79 patients treated with ORIF mandibular repair was completed. The overall infection rate with use of antibiotic prophylaxis was 7.59%, but patients treated with clindamycin had an infection rate of 19.35%. The infection rate when using ampicillin/sulbactam was significantly lower than clindamycin. On the basis of this review, proper antibiotic prophylaxis should cover both potential aerobes and anaerobes.