Arteagoitia M-I, Barbier L, Santamaría J, Santamaría G, Ramos E
Servicio Cirugía Maxilofacial, Hospital Universitario de Cruces, Plaza de Cruces s/n, Barakaldo (Bizkaia), Spain,
Med Oral Patol Oral Cir Bucal. 2016 Jul 1;21(4):e494-504. doi: 10.4317/medoral.21139.
Prophylactic use of amoxicillin and amoxicillin/clavulanic acid, although controversial, is common in routine clinical practice in third molar surgery.
Our objective was to assess the efficacy of prophylactic amoxicillin with or without clavulanic acid in reducing the incidence of dry socket and/or infection after third molar extraction. We conducted a systematic review and meta-analysis consulting electronic databases and references in retrieved articles. We included double-blind placebo-controlled randomized clinical trials published up to June 2015 investigating the efficacy of amoxicillin with or without clavulanic acid on the incidence of the aforementioned conditions after third molar extraction. Relative risks (RRs) were estimated with a generic inverse-variance approach and a random effect model using Stata/IC 13 and Review Manager Version 5.2. Stratified analysis was performed by antibiotic type.
We included 10 papers in the qualitative review and in the quantitative synthesis (1997 extractions: 1072 in experimental groups and 925 in controls, with 27 and 74 events of dry socket and/or infection, respectively). The overall RR was 0.350 (p<0.001; 95% CI 0.214 to 0.574). We found no evidence of heterogeneity (I2=0%, p=0.470). The number needed to treat was 18 (95% CI 13 to 29). Five studies reported adverse reactions (RR=1.188, 95% CI 0.658 to 2.146, p =0.567). The RRs were 0.563 for amoxicillin (95% CI 0.295 to 1.08, p=0.082) and 0.215 for amoxicillin/clavulanic acid (95% CI 0.117 to 0.395, p<0.001).
Prophylactic use of amoxicillin does not significantly reduce the risk of infection and/or dry socket after third molar extraction. With amoxicillin/clavulanic acid, the risk decreases significantly. Nevertheless, considering the number needed to treat, low prevalence of infection, potential adverse reactions to antibiotics and lack of serious complications in placebo groups, the routine prescription of amoxicillin with or without clavulanic acid is not justified.
阿莫西林及阿莫西林/克拉维酸的预防性使用虽存在争议，但在第三磨牙手术的常规临床实践中很常见。
我们的目的是评估含或不含克拉维酸的预防性阿莫西林在降低第三磨牙拔除术后干槽症和/或感染发生率方面的疗效。我们通过查阅电子数据库及检索文章中的参考文献进行了一项系统评价和荟萃分析。我们纳入了截至2015年6月发表的双盲安慰剂对照随机临床试验，这些试验研究了含或不含克拉维酸的阿莫西林对第三磨牙拔除术后上述情况发生率的疗效。使用Stata/IC 13和Review Manager 5.2版本，采用通用逆方差法和随机效应模型估计相对风险（RRs）。按抗生素类型进行分层分析。
我们在定性评价和定量综合分析中纳入了10篇论文（1997例拔牙：试验组1072例，对照组925例，分别有27例和74例发生干槽症和/或感染）。总体RR为0.350（p<0.001；95%CI 0.214至0.574）。我们未发现异质性证据（I2=0%，p=0.470）。治疗所需人数为18（95%CI 13至29）。五项研究报告了不良反应（RR=1.188，95%CI 0.658至2.146，p =0.567）。阿莫西林的RR为0.563（95%CI 0.295至1.08，p=0.082），阿莫西林/克拉维酸的RR为0.215（95%CI 0.117至0.395，p<0.001）。
预防性使用阿莫西林并不能显著降低第三磨牙拔除术后感染和/或干槽症的风险。使用阿莫西林/克拉维酸时，风险显著降低。然而，考虑到治疗所需人数、感染的低发生率、抗生素潜在的不良反应以及安慰剂组中缺乏严重并发症，常规开具含或不含克拉维酸的阿莫西林并不合理。
