School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; IDIBELL (Bellvitge Biomedical Research Institute), Barcelona, Spain.
School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.
Int J Oral Maxillofac Surg. 2024 Jan;53(1):57-67. doi: 10.1016/j.ijom.2023.08.001. Epub 2023 Aug 21.
Clinicians frequently prescribe systemic antibiotics after lower third molar extractions to prevent complications such as surgical site infections and dry socket. A systematic review of randomised clinical trials was conducted to compare the risk of dry socket and surgical site infection after the removal of lower third molars with different prophylactic antibiotics. The occurrence of any antibiotic-related adverse event was also analysed. A pairwise and network meta-analysis was performed to establish direct and indirect comparisons of each outcome variable. Sixteen articles involving 2158 patients (2428 lower third molars) were included, and the following antibiotics were analysed: amoxicillin (with and without clavulanic acid), metronidazole, azithromycin, and clindamycin. Pooled results favoured the use of antibiotics to reduce dry socket and surgical site infection after the removal of a lower third molar, with a number needed to treat of 25 and 18, respectively. Although antibiotic prophylaxis was found to significantly reduce the risk of dry socket and surgical site infection in patients undergoing lower third molar extraction, the number of patients needed to treat was high. Thus, clinicians should evaluate the need to prescribe antibiotics taking into consideration the patient's systemic status and the individual risk of developing a postoperative infection.
临床医生常在下颌第三磨牙拔除术后开具全身用抗生素，以预防手术部位感染和干槽症等并发症。本系统评价对随机临床试验进行了汇总分析，旨在比较不同预防性抗生素在下颌第三磨牙拔除术后发生干槽症和手术部位感染的风险。同时分析了与抗生素相关的任何不良事件的发生情况。采用成对和网状荟萃分析，建立了每种结局变量的直接和间接比较。共纳入了 16 项研究，涉及 2158 名患者（2428 颗下颌第三磨牙），分析了以下抗生素：阿莫西林（含或不含克拉维酸）、甲硝唑、阿奇霉素和克林霉素。汇总结果表明，抗生素的使用可以降低下颌第三磨牙拔除术后干槽症和手术部位感染的风险，分别需要治疗 25 和 18 例患者。尽管抗生素预防治疗可显著降低下颌第三磨牙拔除术后患者发生干槽症和手术部位感染的风险，但需要治疗的患者数量较高。因此，临床医生应评估是否需要开具抗生素，同时考虑患者的全身状况和发生术后感染的个体风险。
