Efficacy of antibiotic prophylaxis in the prevention of postoperative infections in impacted third molar surgery. Systematic review and meta-analysis

Abstract

Introduction: Antibiotic prophylaxis is controversial, besides its inappropriate use puts patients at risk of adverse reactions and the development of bacterial resistance. Objective: To conduct a systematic review of the literature of randomized clinical trials that evaluated the effectiveness of antibiotic prophylaxis in the reduction of postoperative infections after the extraction of impacted third molars. Materials and Methods. The ScienceDirect, Clinical trials.gov and Scopus databases were used to locate clinical trials. The primary variables included: presence of postoperative infections (wound and / or alveolitis), adverse reactions, trismus and pain. Meta-analysis with homogeneous studies was carried out through random effects analysis. The risk of bias of the included trials was assessed through the Cochrane guide. The overall relative risk was calculated using the inverse variance approach with the random effects method. Results: 14 clinical trials were analyzed qualitatively, while 9 were analyzed quantitatively. Of a total of 874 patients, 49 (5.6%) presented postoperative infections (16/446 for the experimental group and 33/428 for the placebo group). The meta-analysis showed an overall relative risk of 0.5 (95% CI: 0.27-0.94). This value is for studies that used only amoxicillin as a prophylactic measure, an OR of 0.53 (95% CI: 0.27-1.03). The main adverse reactions reported included: diarrhea, gastrointestinal reactions, fever and gastric pain. Conclusions: Systemic antibiotics administered before surgery were effective in reducing the frequency of postoperative infections after extraction of impacted third molars.

Keywords

• metaanálisis
• profilaxis antibiótica
• tercer molar
• alveolo seco
• cirugía bucal