Background:
Approximately 3 million individuals suffer craniofacial trauma in the United States each year. The benefit of antibiotic prophylaxis following craniofacial trauma is to reduce the risks of infection, but there exists wide variations in practice patterns of antibiotic prophylaxis among institutions.
A systematic review of literature regarding antibiotic prophylaxis in facial fracture was completed by Mundinger, et al. in 2015. A total of 44 studies were identified, but noted to be of poor quality due to lack of adequate study design and data analysis. Ultimately, the investigators concluded frequent use of pre- and post-operative antibiotics in upper and midface fractures is not supported by literature recommendations (low-level evidence). Prophylactic antibiotic use in comminuted mandible fractures is supported, but post-operative antibiotic prophylaxis is not (higher level of evidence).
Due to the variability in practice patterns, the Surgical Infection Society (SIS) developed guidance in 2020 for antibiotic administration for patients with facial fractures. Recommendations include the following, in adult patients with: (1) non-operative upper face, midface, or mandibular fractures, prophylactic antibiotics not be prescribed, (2) operative, non-mandibular fractures, preoperative antibiotics likewise not be prescribed, (3) operative, mandibular fractures, pre-operative antibiotics not be prescribed, (4) operative, non-mandibular facial fractures, post-operative (>24 hours) antibiotics not be prescribed, and (5) operative, mandibular facial fractures, post-operative antibiotics (> 24 hours) not be prescribed.
This document is intended to serve only as a guideline based on current review of medical literature, and not intended to replace clinical judgement, physician/surgeon discretion, or special circumstances.
Resources:
1. Kyzas PA. Use of antibiotics in the treatment of mandible fractures: a systematic review. J Oral Maxillofac Surg 2011; 69(4):1129-1145.
2. Mundinger G, Borsuk D, Okhah Z, Christy M, Bojuvic B, Dorafshar A, Rodriguez E. Antibiotic and Facial Fractures: Evidence-Based Recommendations Compared with Experience-Based Practice. Craniomaxillofac Trauma Reconstr 2015; 8(1):64-78.
3. Forrester, JD, Wolff CJ, Choi J, Colling KP, Huston, JM. Surgical Infection Society Guidelines for Antibiotic Use in Patients with Traumatic Facial Fractures. Surgical Infections 2020; online ahead of print.
4. Zosa BM, Elliott CW, Kurlander DE, Johnson F, Ho VP, Claridge JA. Facing the facts on prophylactic antibiotics for facial fractures: 1 day or less. J Trauma Acute Care Surg 2018; 85(3):444-450.
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6. Linkugel AD, Odom EB, Bavolek RA, Snyder-Warwick AK, Patel KB. Systemic Preoperative Antibiotics with Mandible Fractures: Are They Indicated at the Time of Injury? Craniomaxillofac Trauma Reconstr 2018; 11(1):35-40.
7. Chole RA, Yee J. Antibiotic prophylaxis for facial fractures. A prospective, randomized clinical trial. Arch Otalaryngol Head Neck Surg 1987; 113(10):1055-1057.
8. Baliga SD, Bose A, Jain S The evaluation of efficacy of post-operative antibiotics in the open reduction of the zygomatic and mandibular fracture: a prospective trial. J Maxillofac Oral Surg 2014; 13(2):165–175.
9. Soong PL, Schaller B, Zix J, Lizuka T, Mottini M, Liegger O. The role of postoperative prophylactic antibiotics in the treatment of facial fractures: a randomized, double-blind, placebo-controlled pilot clinical study. Part 3: Le Fort and zygomatic fractures in 94 patients. Br J Oral Maxillofac Surg 2014; 52(4):329-333.
10. Schaller B, Soong PL, Zix J, Lizuka T, Liegger O. The role of postoperative prophylactic antibiotics in the treatment of facial fractures: a randomized, double-blind, placebo-controlled pilot clinical study. Part 2: Mandibular fractures in 59 patients. Br J Oral Maxillofac Surg 2013; 51(8):803-807.
11. Zix J, Schaller B, Lizuka T, Lieger O. The role of postoperative prophylactic antibiotics in the treatment of facial fractures: a randomized, double-blind, placebo-controlled pilot clinical study. Part 1: orbital fractures in 62 patients. Br J Oral Maxillofac Surg 2013; 51(4):332-336.