Postoperative Antibiotics May Be Unnecessary in Pediatric Patients Hospitalized With Minor Odontogenic Infections

Antibiotic overuse is a growing concern in health care. For pediatric odontogenic infections, the necessity of postoperative antibiotics lacks clear, evidence-based guidelines.

The purpose of this study was to compare treatment outcomes between pediatric patients hospitalized with vestibular space odontogenic infections who received postoperative antibiotics and those who did not.

This ambispective cohort study was conducted at the Baruch Padeh "Tzafon" Medical Center, Poriya, Israel (January 2010-December 2015 for retrospective and November 2018-December 2019 for prospective). The sample included 522 pediatric patients (<15 years) hospitalized for odontogenic infections requiring surgical intervention. Patients with nonodontogenic infections, compromised immune systems, or infections involving deeper spaces were excluded.

The primary predictor was postoperative antibiotic management (administration vs no administration), decided at hospital admission.

The primary outcome variable was hospital length of stay (LOS), categorized as short (1 to 2 days) or extended (≥3 days). LOS was chosen as a proxy for recovery time and symptom resolution, reflecting the overall efficacy of the treatment approach.

Demographic, clinical, and laboratory data were collected.

Descriptive statistics, Student t-tests, χ² tests, and multivariable logistic regression were used (P < .05).

Of 522 patients (411 control, 111 study), mean LOS was similar between groups: 1.7 ± 0.91 days (control) versus 1.67 ± 0.9 days (study) (P = .76). Short stays were not significantly different (90.99 vs 87.10%, P = .32). Multivariable analysis showed no association between withholding antibiotics and extended stay (odds ratio [OR] = 0.92, 95% confidence interval [CI]: 0.45 to 1.89, P = .82), but identified age (OR = 1.11, 95% CI: 1.02 to 1.21, P = .02) and initial white blood cell count (OR = 1.08, 95% CI: 1.01 to 1.15, P = .03) as predictors of extended stay.

Withholding routine postoperative antibiotics in pediatric patients with odontogenic infections does not significantly impact length of hospital stay. While length of stay is not a direct measure of clinical outcome, it serves as a proxy for recovery. This approach may contribute to antibiotic stewardship efforts without compromising patient care, though future studies with direct clinical outcome measures are needed to confirm these findings.