Reevaluating antibiotic prophylaxis: insights from a network meta-analysis on dry socket and surgical site infections

Area of Science:

• Oral and Maxillofacial Surgery
• Evidence-Based Dentistry
• Pharmacology

Background:

• Surgical site infection (SSI) and dry socket (DS) are potential complications following lower third molar (L3M) extraction.
• The role of oral antibiotic prophylaxis (ABP) in preventing these complications remains a subject of clinical debate and research.

Purpose of the Study:

• To systematically review and synthesize evidence from randomized clinical trials (RCTs) on the efficacy of ABP in preventing DS and SSI after L3M extraction.
• To evaluate the risk of bias and quality of evidence for included studies.

Main Methods:

• A systematic search of MEDLINE, Cochrane Library, and Scopus databases was conducted for RCTs published between 1999 and 2021.
• Three reviewers applied PICO criteria for study selection, focusing on healthy patients undergoing L3M extraction with ABP, placebo, or no treatment.
• Data extraction and synthesis included antibiotic types, dosages, and outcomes (DS, SSI, adverse effects), utilizing pairwise and network meta-analyses. Study quality was assessed using the Cochrane Collaboration tool and GRADE.

Main Results:

• Sixteen RCTs were included in the meta-analysis.
• Pooled results indicated that ABP significantly reduces the incidence of DS (Number Needed to Treat [NNT] = 25) and SSI (NNT = 18) following L3M extraction.
• Two studies had a low risk of bias, but the overall quality of evidence was determined to be low according to GRADE criteria.

Conclusions:

• Oral antibiotic prophylaxis demonstrates a clear benefit in reducing the risk of DS and SSI after lower third molar extraction.
• Prescribing decisions for ABP should carefully consider individual patient systemic conditions and risk factors to mitigate the broader threat of antimicrobial resistance.