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Do antibiotics prevent infection after third molar surgery? A network meta-analysis
S G M Falci1, E L Galvão1, G M de Souza1
1Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
Abstract:
The aim of this systematic review was to determine whether antibiotics, compared to placebo, can prevent infection or dry socket after third molar surgery. A systematic review and network meta-analysis (NMA) was performed following registration of the protocol (CRD42021276266). Four databases and the grey literature were searched, and papers were selected based on the PICOS question. RoB 2 and GRADE were used to evaluate the risk of bias and certainty of the evidence, respectively. The NMA was performed using Stata. Of 58 randomized clinical trials identified, 34 were included in the NMA. Patients treated with amoxicillin (relative risk (RR) 0.56, 95% confidence interval (CI) 0.38-0.84; low quality of evidence) and those treated with metronidazole (RR 0.51, 95% CI 0.31-0.84; low quality of evidence) showed a lower risk of infection and dry socket when compared to patients given a placebo. Postoperative amoxicillin (750 mg) and amoxicillin plus clavulanate (500 mg + 125 mg, or 2000 mg + 125 mg), and preoperative metronidazole (800 mg) are useful to prevent infection or dry socket when compared to placebo. The low rate of infection after third molar surgery, the correct concept of antibiotic prophylaxis, and antibiotic resistance must be taken into account when choosing to treat healthy patients undergoing third molar surgery with antibiotics.
Insights
Antibiotics like amoxicillin and metronidazole can help prevent infection and dry socket after third molar surgery compared to placebo. However, consider antibiotic resistance and the low infection rate in healthy patients.
Area of Science:
- Oral and Maxillofacial Surgery
- Infectious Diseases
- Pharmacology
Background:
- Third molar surgery is associated with risks of infection and dry socket.
- The prophylactic use of antibiotics is a common practice, but its efficacy requires systematic evaluation.
Purpose of the Study:
- To systematically review and perform a network meta-analysis (NMA) on the effectiveness of antibiotics versus placebo in preventing infection or dry socket after third molar surgery.
Main Methods:
- Systematic review and NMA of 34 randomized clinical trials (RCTs) from 58 identified studies.
- Searches conducted across four databases and grey literature, with study selection based on PICOS criteria.
- Risk of bias (RoB 2) and certainty of evidence (GRADE) were assessed.
Main Results:
- Amoxicillin (RR 0.56) and metronidazole (RR 0.51) significantly reduced the risk of infection and dry socket compared to placebo (low quality of evidence).
- Specific effective regimens include postoperative amoxicillin, amoxicillin plus clavulanate, and preoperative metronidazole.
- The observed effects were based on a low certainty of evidence.
Conclusions:
- Antibiotics, specifically amoxicillin and metronidazole, demonstrate efficacy in preventing infection and dry socket post-third molar surgery.
- Clinical decisions regarding antibiotic prophylaxis should weigh benefits against the low incidence of infection and the potential for antibiotic resistance.
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