Effectiveness of Antimicrobial Prophylaxis in Preventing the Spread of Infection as a Result of Oral Procedures: A Systematic Review and Meta-Analysis

Purpose: To determine the effectiveness of prophylactic antibiotics for preventing localized infections of the oral cavity, neck, and thoracic cavity in patients undergoing oral procedures. Materials and Methods: A systematic review and meta-analysis was performed. A search strategy was applied to the Medline database through Ovid, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials, and OpenGrey. Clinical trials were included, and studies in which patients underwent procedures outside the oral cavity were excluded. Statistical analysis was performed using Stata 13 and RevMan 5.3. A risk of bias assessment was performed according to Cochrane recommendations. Results: For the primary results of oral cavity infection with antibiotic intervention versus placebo, 6 studies with a risk difference (RD) of -0.025 were included (95% confidence interval [CI], -0.043 to -0.007). For bacteremia with antibiotic intervention versus placebo, 7 studies with an RD of -0.278 were included (95% CI, -0.380 to -0.176); when an analysis of antibiotic versus antibiotic was performed, 6 studies with an RD -0.072 were included (95% CI, -0.255 to -0.112), favoring antibiotic prophylaxis. There was no evidence of neck and thoracic cavity infection. For type of treatment, implant surgery with placebo showed an RD of -0.021 (95% CI, -0.043 to 0.001), whereas an RD -0.245 was observed when performing tooth extraction (95% CI, -0.337 to -0.154). Conclusion: The incidence of infections in the oral cavity decreased with the use of antibiotic prophylaxis in patients undergoing tooth extraction. However, for implant surgery and endodontic surgery, prophylactic antibiotic showed no differences compared with placebo. No infections in the neck or thoracic cavity were reported. It is necessary to evaluate antibiotic prophylaxis in high-risk patients. (C) 2016 American Association of Oral and Maxillofacial Surgeons.