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European Journal of Oral and Maxillofacial Surgery 2022 August;6(2):71-5

DOI: 10.23736/S2532-3466.22.00281-8

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Effects of shortened course of antimicrobials in surgical management of midface fractures

Mark LAWRENCE , Rishi KARIA, Katherine GEORGE

OMFS Department, Kings College Hospital, London, UK



BACKGROUND: Antimicrobial resistance is an increasing challenge confronting healthcare professional and posing a serious threat to global public health. Without effective antimicrobials, the success of major surgery can be compromised, undermining many advances in healthcare. A pilot study within our OMFS Department demonstrated perioperative use of various antimicrobials for varied lengths of time when surgically managing facial fractures. As per the World Health Organization global action plan on antimicrobial resistance, with our microbiology team we developed and implemented a shortened antimicrobial protocol for use in the surgical management of midfacial fractures.
METHODS: A prospective study investigated the effects a shortened course of perioperative antimicrobial cover had on infective postoperative complications in patients who had surgical management of midfacial fractures.
RESULTS: Of 50 patients who underwent surgical management of midfacial fractures 28/50 (56%) were prescribed a shortened course of perioperative antimicrobials depending on whether an intra- or extra-oral surgical approach was used, whilst 22/50 (44%) were prescribed a longer course of antimicrobials. Of those given a shortened course of antimicrobials 1/28 (3.6%) experienced infective postoperative complications. Conversely 4/22 (18.2%) of those given a longer course of antibiotics experienced infective postoperative complications.
CONCLUSIONS: This data support growing evidence that shorter courses of antimicrobials are appropriate in the surgical management of facial fractures. As surgeons we can utilize evidence-based medicine to provide optimal surgical care whilst simultaneously contributing to healthcare professionals’ obligations to tackle the increasing challenge of antimicrobial resistance.


KEY WORDS: Maxillofacial injuries; Anti-bacterial agents; Fractures, bone

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