Antibiotics and facial fractures: evidence-based recommendations compared with experience-based practice

Area of Science:

• Plastic Surgery
• Oral and Maxillofacial Surgery
• Infectious Disease Management

Background:

• The efficacy of prophylactic antibiotics in managing craniofacial fractures remains a subject of debate.
• Current clinical practices for antibiotic prophylaxis in facial fracture management vary significantly among experts.

Purpose of the Study:

• To compare evidence-based literature recommendations with expert clinical practices regarding antibiotic prophylaxis in facial fracture management.
• To evaluate the efficacy of pre-, peri-, and postoperative antibiotic use across different facial thirds.

Main Methods:

• A systematic review identified 44 studies on antibiotic prophylaxis in facial fractures, assessing evidence levels using American Society of Plastic Surgery criteria.
• Expert opinions were collected via surveys at the Advanced Orbital Surgery Symposium, detailing antibiotic prescribing habits.

Main Results:

• Literature suggests perioperative antibiotics for all facial thirds and preoperative antibiotics for comminuted mandible fractures; postoperative antibiotics are not supported.
• Expert surveys revealed frequent pre- and postoperative antibiotic use in upper and midface fractures, despite limited supporting evidence.
• Mandible fractures showed a higher adherence to literature recommendations for preoperative antibiotic use.

Conclusions:

• Evidence-based recommendations for antibiotic prophylaxis in facial fractures are not consistently followed in expert practice.
• The quality of existing studies is generally poor, highlighting the need for higher-level research to guide clinical decision-making.
• Optimizing antibiotic prescribing for craniofacial fractures requires further investigation into efficacy and adherence to guidelines.