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Prophylactic Antibiotic Therapy in Cleft Surgery-A Scoping Review.

Margareta Budner1,2, Marcelina Podleśna2,3, Aleksandra Domańska4

  • 1Department of Jaw Orthopedics, Medical University of Lublin, 20-059 Lublin, Poland.

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Prophylactic antibiotic use in cleft lip and palate surgery shows wide variation. Short-course antibiotic strategies appear effective, highlighting the need for resistance-conscious guidelines and further research.

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Area of Science:

  • Craniofacial surgery
  • Infectious disease
  • Pharmacology

Background:

  • Cleft lip and/or palate surgeries are clean-contaminated procedures susceptible to surgical site infections and palatal fistulas.
  • Current perioperative antibiotic use lacks standardized, evidence-based recommendations.
  • Rising antimicrobial resistance necessitates rational antibiotic prescribing in surgical settings.

Purpose of the Study:

  • To systematically map existing evidence on prophylactic antibiotic therapy in cleft surgery.
  • To identify related perioperative measures influencing outcomes.
  • To inform the development of standardized, resistance-conscious guidelines.

Main Methods:

  • A systematic scoping review following the Arksey and O'Malley framework, adhering to PRISMA 2020 guidelines.
  • Searched PubMed, Mendeley, and Google Scholar (Jan 2015-Feb 2025) for relevant English-language studies.
  • Data extraction by six reviewers focused on study characteristics, antibiotic regimens, and outcomes.

Main Results:

  • Forty studies met inclusion criteria, revealing significant variation in antibiotic choice, timing, and duration.
  • Single-dose perioperative prophylaxis demonstrated non-inferiority to prolonged courses in some cases.
  • Oral microbiota analysis indicated colonization by resistant pathogens in cleft patients.

Conclusions:

  • Evidence supports individualized, short-course perioperative antibiotic strategies over routine prolonged therapy.
  • Further high-quality randomized controlled trials and microbiological studies are essential.
  • Development of standardized, antimicrobial resistance-aware guidelines is needed for cleft surgery.