Use of antibiotics in the treatment of mandible fractures: a systematic review.

PURPOSE: The use of prophylactic antibiotics in the treatment of mandible fractures is common practice. The evidence supporting this practice has not been formally assessed for quality. The purpose of this study was to evaluate this empirically.
MATERIALS AND METHODS: Randomized and nonrandomized trials evaluating the possible impact of the prophylactic use of antibiotics in patients with mandible fractures were identified. Data were extracted on characteristics of studies and patients, including treatment, fracture location, time from injury to treatment, antibiotics used (type, route, dosage, duration), and complications (infection, malunion, reoperation). Randomized controlled trials (RCTs) were further evaluated for issues of reported methodological quality.
RESULTS: There were 31 eligible studies (5,437 patients). Of these, 9 were prospective RCTs; the remaining 22 were retrospective case series. Information about the time between injury and definite treatment was provided by 10 studies (31%). The type of antibiotic used was not defined in 13 of 31 studies (42%). Half of the studies (15 of 31 [48%]) did not describe the route of administration and did not comment on the duration of the antibiotic course. The vast majority (23 of 31 [74%]) did not describe the dosage of the antibiotics used. Most of the RCTs were small, had not adequately described the mode of randomization, and did not present intention-to-treat analyses. None of them presented power calculations or ensured allocation concealment. There was not a single mention about number needed to treat. The amount and quality of the available data precluded formal quantitative synthesis, despite scattered signals that prophylactic antibiotics may be better than nothing in preventing infection.
CONCLUSION: The overall evidence to support the use of prophylactic antibiotics in mandible fractures is of poor quality. Large RCTs are needed to guide clinical practice.