Amoxicillin vs third-generation cephalosporin for infection prophylaxis after third molar extraction

Area of Science:

• Dentistry
• Infectious Diseases
• Pharmacology

Background:

• Amoxicillin is the recommended prophylactic antibiotic for impacted mandibular third molar extraction.
• Third-generation cephalosporins are frequently used in Japan despite limited real-world evidence.
• This study addresses the gap in evidence regarding antibiotic choice for this procedure.

Purpose of the Study:

• To compare the incidence of surgical site infection (SSI) after impacted mandibular third molar extraction.
• To evaluate the effectiveness of amoxicillin versus third-generation cephalosporins in preventing SSI.
• To provide real-world evidence to guide antibiotic prophylaxis in dental surgery.

Main Methods:

• A retrospective analysis of the JMDC Claims Database (April 2015-March 2020).
• Identification of patients undergoing impacted mandibular third molar extraction.
• One-to-one propensity score matching between amoxicillin and third-generation cephalosporin groups.
• Comparison of SSI incidence using McNemar's test.

Main Results:

• 109,266 dental visits were analyzed; 36.2% received amoxicillin, 63.8% received third-generation cephalosporins.
• In 39,514 matched pairs, SSI incidence was 3.5% for amoxicillin and 3.7% for third-generation cephalosporins (p=0.003).
• Amoxicillin was associated with a statistically significant lower SSI rate.

Conclusions:

• Amoxicillin is associated with a lower incidence of surgical site infection compared to third-generation cephalosporins for impacted mandibular third molar extraction.
• Findings support current clinical guidelines recommending amoxicillin.
• Emphasizes the need for antimicrobial resistance control and evidence-based prescribing in dentistry.