Prophylactic Antibiotic Therapy in Cleft Surgery-A Scoping Review

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.